Provider Demographics
NPI:1962563320
Name:POLK, CHRISTOPHER W (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:POLK
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 1:2020 N WEBB RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3410
Mailing Address - Country:US
Mailing Address - Phone:316-687-2110
Mailing Address - Fax:316-636-9539
Practice Address - Street 1:2020 N WEBB RD STE 301
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3410
Practice Address - Country:US
Practice Address - Phone:316-687-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7205122300000X, 1223G0001X
KS605931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist