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General NPI Number Information
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NPI Number | 1922407584
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Entity Type | Organization
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Legal Business Name | CHRISTOPHERSON & CALDWELL ORTHODONTICS
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 3875 BURTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5816
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Country | US
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Telephone | 616-949-7510
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Fax | 616-949-6051
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Provider Business Mailing Address
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Address Line | 3875 BURTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5816
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH CHRISTOPHERSON
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Credential | D.D.S., M.S.
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Telephone | 616-949-7510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901011536
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License Number State | MI
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