Provider Demographics
NPI:1528270022
Name:FORTIN, CHRISTOPHER C (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:FORTIN
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 1:65 N DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4265
Mailing Address - Country:US
Mailing Address - Phone:302-734-7634
Mailing Address - Fax:
Practice Address - Street 1:65 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4265
Practice Address - Country:US
Practice Address - Phone:302-734-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice