Provider Demographics
NPI:1588141543
Name:CHRISTOPHER, NOAH M (DDS)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:M
Last Name:CHRISTOPHER
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:BLDG 1022, RM 226
Mailing Address - Street 2:398 192ND ARMORED TANK BN ROAD
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121
Mailing Address - Country:US
Mailing Address - Phone:502-624-6158
Mailing Address - Fax:
Practice Address - Street 1:BLDG 1022, RM 226
Practice Address - Street 2:398 192ND ARMORED TANK BN ROAD
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121
Practice Address - Country:US
Practice Address - Phone:502-624-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist