=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134387616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL S CHRISTIE III DDS PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2008
-----------------------------------------------------
Last Update Date | 05/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2015 HOLTON RD
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49445-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-744-4784
-----------------------------------------------------
Fax | 231-744-0601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2015 HOLTON RD
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49445-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-744-4784
-----------------------------------------------------
Fax | 231-744-0601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PAUL S CHRISTIE III
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 231-744-7484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 11281
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------