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General NPI Number Information
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NPI Number | 1992924427
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Entity Type | Individual
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Provider Name | STEPHEN EUGENE CHRISTY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 2071 COLLIER CORPORATE PKWY
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City | SAINT CHARLES
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State | MO
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Zip | 63303-6701
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Country | US
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Telephone | 636-947-7979
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Fax | 636-947-3553
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Provider Business Mailing Address
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Address Line | 322 MONTICELLO PL
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3195
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Country | US
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Telephone | 618-910-3255
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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 | 019026823
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License Number State | IL
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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 | 2006007560
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License Number State | MO
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