MEDICARE: DR. CHRISTOPHER L BIBLE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	120-10301	IN

General Provider Information

NPI Number	:	1083777874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER L BIBLE D.D.S.

Provider Business Mailing Address
First Line	:	3812 N WASHINGTON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1816
Country	:	US
Telephone Number	:	260-432-6242
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6809
Country	:	US
Telephone Number	:	260-435-1968
Fax Number	:	260-435-1971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/09/2007

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