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General NPI Number Information
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NPI Number | 1194066167
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Entity Type | Organization
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Legal Business Name | CHRISTMAN DENTAL, LTD
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Dates
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Enumeration Date | 03/15/2013
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 425 W PRAIRIE VIEW ROAD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3389
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Country | US
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Telephone | 715-726-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 425 W PRAIRIE VIEW ROAD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3389
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Country | US
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Telephone | 715-726-1060
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BLANE R CHRISTMAN
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Credential | DDS
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Telephone | 715-726-1060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 6466
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4080
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License Number State | WI
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