Provider Demographics
NPI:1063857589
Name:BANNON, CHRISTOPHER MICHAEL (DMD, MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:BANNON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 PATTON CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5770
Mailing Address - Country:US
Mailing Address - Phone:205-979-9738
Mailing Address - Fax:205-979-9760
Practice Address - Street 1:2036 PATTON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5770
Practice Address - Country:US
Practice Address - Phone:205-979-9738
Practice Address - Fax:205-979-9760
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL60941223G0001X, 204E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program