MEDICARE: DR. CHRISTOPHER GURRIES 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	63526	CA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401416451	VA
3	171000000X	Military Health Care Provider
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	63526	CA

General Provider Information

NPI Number	:	1750700837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER GURRIES D.D.S.

Provider Business Mailing Address
First Line	:	633D MDG ORAL AND MAXILLOFACIAL SURGERY
Second Line	:	77 NEALY AVE
City	:	LANGLEY AFB
State	:	VA
Zip	:	23665
Country	:	US
Telephone Number	:	757-764-7124
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 SUTTER ST RM 2439
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-4208
Country	:	US
Telephone Number	:	415-956-6610
Fax Number	:	415-956-6618

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

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	03/24/2022

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