Provider Demographics
NPI:1699953281
Name:CHRISTIE, DIANA (DMD, MBA)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:DMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 15TH ST STE 812
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1143
Mailing Address - Country:US
Mailing Address - Phone:310-393-8233
Mailing Address - Fax:
Practice Address - Street 1:1260 15TH ST STE 812
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1143
Practice Address - Country:US
Practice Address - Phone:310-393-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist