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General NPI Number Information
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NPI Number | 1124228242
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Entity Type | Individual
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Provider Name | CHRISTOPHER EDOBOR EGEDE DDS
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Gender | Male
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 4501 MAPLE AVE
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City | DALLAS
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State | TX
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Zip | 75219-1830
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Country | US
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Telephone | 214-443-9404
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Fax | 214-443-9401
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Provider Business Mailing Address
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Address Line | 5436 MONTAGUE LN
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-2695
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Country | US
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Telephone | 214-443-9404
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Fax | 214-443-9401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23392
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License Number State | TX
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