Provider Demographics
NPI:1609619253
Name:CHRISTIAN A VICTOR DDS INC
Entity type:Organization
Organization Name:CHRISTIAN A VICTOR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-215-3615
Mailing Address - Street 1:1980 KINGSGATE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8226
Mailing Address - Country:US
Mailing Address - Phone:937-390-3077
Mailing Address - Fax:
Practice Address - Street 1:1980 KINGSGATE RD STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8226
Practice Address - Country:US
Practice Address - Phone:937-390-3077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental