Provider Demographics
NPI:1467849679
Name:GREENWALDT, CHRISTOPHER LEE (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:GREENWALDT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4620
Mailing Address - Country:US
Mailing Address - Phone:312-607-8106
Mailing Address - Fax:
Practice Address - Street 1:6050 BRYNWOOD DR STE 205
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6579
Practice Address - Country:US
Practice Address - Phone:815-201-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-26
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0302231223G0001X, 1223G0001X
WI1001283-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice