Provider Demographics
NPI:1558440990
Name:UPHAM, CHRISTOPHER ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:UPHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1200
Mailing Address - Country:US
Mailing Address - Phone:661-259-9750
Mailing Address - Fax:661-259-9797
Practice Address - Street 1:23206 LYONS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2667
Practice Address - Country:US
Practice Address - Phone:661-259-9750
Practice Address - Fax:661-259-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA214131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA88790Medicare UPIN
CA953246810Medicare ID - Type UnspecifiedFEDERAL TAX ID