Provider Demographics
NPI:1154617686
Name:DESESA, CHRISTOPHER ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:DESESA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:75 VAN DEENE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3258
Mailing Address - Country:US
Mailing Address - Phone:413-788-9621
Mailing Address - Fax:413-788-0103
Practice Address - Street 1:75 VAN DEENE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3258
Practice Address - Country:US
Practice Address - Phone:413-788-9621
Practice Address - Fax:413-788-0103
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0115211223S0112X
MADN18568241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery