Provider Demographics
NPI:1962079806
Name:FITE, CHRISLYN LEE (DMD)
Entity type:Individual
Prefix:
First Name:CHRISLYN
Middle Name:LEE
Last Name:FITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 CAVE MILL RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6337
Mailing Address - Country:US
Mailing Address - Phone:270-770-0250
Mailing Address - Fax:
Practice Address - Street 1:1960 CAVE MILL RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6337
Practice Address - Country:US
Practice Address - Phone:270-770-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist