=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821199605
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILLIP MC LEAN CHRISTIE D.D.S., M.A.G.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23192 THREE NOTCH RD
-----------------------------------------------------
City | CALIFORNIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20619-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-862-2231
-----------------------------------------------------
Fax | 301-862-1981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23149 CRESTWOOD LN
-----------------------------------------------------
City | CALIFORNIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20619-6013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-862-2994
-----------------------------------------------------
Fax | 301-862-1981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 9376
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------