Provider Demographics
NPI:1487341103
Name:EDMUNDS, CHRISTOPHER MCKAY (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MCKAY
Last Name:EDMUNDS
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 1:15120 S PLYMOUTH ROCK LN APT C4
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-5045
Mailing Address - Country:US
Mailing Address - Phone:801-380-1312
Mailing Address - Fax:
Practice Address - Street 1:793 E WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7564
Practice Address - Country:US
Practice Address - Phone:801-281-9517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13346226-9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist