MEDICARE: DR. CHRISTOPHER L PODLIN DMD

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	122300000X	Dentist	21121	MA
2	1223G0001X	General Practice Dentistry	21121	MA

General Provider Information

NPI Number	:	1659365625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER L PODLIN DMD

Provider Business Mailing Address
First Line	:	48TH MEDICAL GROUP, RAF LAKENHEATH
Second Line	:	UNIT 5115
City	:	APO
State	:	AE
Zip	:	09461-5115
Country	:	US
Telephone Number	:	314-226-8010
Fax Number	:

Provider Business Practice Location Address
First Line	:	48TH MEDICAL GROUP
Second Line	:	RAF LAKENHEATH, UNIT 5115
City	:	APO
State	:	AE
Zip	:	09461
Country	:	US
Telephone Number	:	314-226-8010
Fax Number	:

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	09/07/2021

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