Provider Demographics
NPI:1245416569
Name:GUDAS, CHRISTINE J (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:GUDAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13361 LINCOLN PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-9639
Mailing Address - Country:US
Mailing Address - Phone:219-374-2400
Mailing Address - Fax:219-374-2750
Practice Address - Street 1:13361 LINCOLN PLAZA WAY
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303-9639
Practice Address - Country:US
Practice Address - Phone:219-374-2400
Practice Address - Fax:219-374-2750
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011020A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200867070Medicaid