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General NPI Number Information
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NPI Number | 1609894864
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Entity Type | Individual
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Provider Name | CHRISTOPHER ERIC WACKER DDS
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 25884 BUSINESS CENTER DRIVE #F
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City | REDLANDS
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State | CA
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Zip | 92374
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Country | US
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Telephone | 909-796-2507
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Fax | 909-796-3247
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Provider Business Mailing Address
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Address Line | 25884 BUSINESS CENTER DRIVE #F
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City | REDLANDS
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State | CA
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Zip | 92374
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Country | US
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Telephone | 909-796-2507
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Fax | 909-796-3247
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 43267
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License Number State | CA
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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 | 43267
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License Number State | CA
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