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General NPI Number Information
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NPI Number | 1760830350
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Entity Type | Individual
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Provider Name | CHRISTINE DO D.D.S
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Gender | Female
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 16330 SE 256TH ST
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City | COVINGTON
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State | WA
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Zip | 98042-4233
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Country | US
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Telephone | 253-246-7403
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Fax |
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Provider Business Mailing Address
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Address Line | 3957 MARS CT
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City | SAN JOSE
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State | CA
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Zip | 95121-3229
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Country | US
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Telephone | 408-623-0635
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60642134
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60642134
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License Number State | WA
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