Provider Demographics
NPI:1386704815
Name:CHRISTIAN, PAUL R (DMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 E MAIN ST
Mailing Address - Street 2:ASHLEY PLAZA
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1463
Mailing Address - Country:US
Mailing Address - Phone:302-376-9600
Mailing Address - Fax:
Practice Address - Street 1:423 E MAIN ST
Practice Address - Street 2:ASHLEY PLAZA
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1463
Practice Address - Country:US
Practice Address - Phone:302-376-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00010551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000947908Medicaid