Basic Information
| Provider Information | |||||||||
| NPI: | 1811433725 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEBEDIAH S. CHRISTY, D.D.S.- NORTH CHARLESTON, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3189 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132203189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154546000 | ||||||||
| FaxNumber: | 3154105531 | ||||||||
| Practice Location | |||||||||
| Address1: | 7398 RIVERS AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294064613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434055800 | ||||||||
| FaxNumber: | 8435530522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2017 | ||||||||
| LastUpdateDate: | 01/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTY | ||||||||
| AuthorizedOfficialFirstName: | JEBEDIAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/DDS | ||||||||
| AuthorizedOfficialTelephone: | 8434055800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 8613 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.