Provider Demographics
NPI:1386132447
Name:PAE, CHRISTOPHER DABIN
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DABIN
Last Name:PAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WHISTLER CT UNIT 402
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8431
Mailing Address - Country:US
Mailing Address - Phone:917-386-7419
Mailing Address - Fax:
Practice Address - Street 1:88 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4385
Practice Address - Country:US
Practice Address - Phone:518-798-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0610851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry