Provider Demographics
NPI:1730885914
Name:CHRISTOPHER POWELL, DDS PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:CHRISTOPHER POWELL, DDS PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-730-4111
Mailing Address - Street 1:8866 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8321
Mailing Address - Country:US
Mailing Address - Phone:616-730-4111
Mailing Address - Fax:616-730-4115
Practice Address - Street 1:2360 76TH ST SW STE A
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8524
Practice Address - Country:US
Practice Address - Phone:616-730-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty