Provider Demographics
NPI:1427348143
Name:CHRISTIAN, SCOTT T (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 E PRAIRIE RD
Mailing Address - Street 2:#209
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1642
Mailing Address - Country:US
Mailing Address - Phone:708-602-7892
Mailing Address - Fax:
Practice Address - Street 1:1149 WEILAND RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-7006
Practice Address - Country:US
Practice Address - Phone:847-634-4773
Practice Address - Fax:847-634-6562
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist