Provider Demographics
NPI:1457793226
Name:DUDZIK, CHRISTOPHER MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:DUDZIK
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 1:4403 MARLBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4727
Mailing Address - Country:US
Mailing Address - Phone:619-282-7060
Mailing Address - Fax:
Practice Address - Street 1:2815 JEFFERSON ST STE 300
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1717
Practice Address - Country:US
Practice Address - Phone:760-434-3103
Practice Address - Fax:760-434-3108
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice