Basic Information
| Provider Information | |||||||||
| NPI: | 1811313653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BODE | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | SIRNA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIT 3690 | ||||||||
| Address2: | |||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 091263690 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 42D MEDICAL GROUP | ||||||||
| Address2: | 300 TWINING ST BLDG 760 | ||||||||
| City: | MAXWELL AFB | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3349533368 | ||||||||
| FaxNumber: | 3349538607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2014 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 122300000X | 6118 | AL | Y | Dental Providers | Dentist |
No ID Information.