Dr Christopher Paul Kittle, DDS | |
7223 Mississippi Ave, Bldg #1561, Attn: Credentials Coordinator, Fort Polk, LA 71459-5110 | |
(337) 531-2327 | |
(337) 531-6356 |
Full Name | Dr Christopher Paul Kittle |
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Gender | Male |
Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 7223 Mississippi Ave, Bldg #1561, Fort Polk, Louisiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1437343829 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | 6427 (Louisiana) | Primary |
1223S0112X | Dentist - Oral And Maxillofacial Surgery | L476270 (Michigan) | Secondary |
Entity Name | Great Lakes Oral Surgery And Implants Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1902993819 PECOS PAC ID: 2567471980 Enrollment ID: O20060413000057 |
Mailing Address | Practice Location Address |
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Dr Christopher Paul Kittle, DDS 7223 Mississippi Avenue, Bldg #1561, Usa Dental Activity Attn: Credentials Coordinator, Fort Polk, LA 71459-5110 Ph: (337) 531-2327 | Dr Christopher Paul Kittle, DDS 7223 Mississippi Ave, Bldg #1561, Attn: Credentials Coordinator, Fort Polk, LA 71459-5110 Ph: (337) 531-2327 |
Maria Alma Martinez, DMD Dentist Medicare: Medicare Enrolled Practice Location: 7223 Mississippi Ave, Fort Polk, LA 71459 Phone: 337-531-4962 | |
Dr. Dona Taherizadegan, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 5622 Bazydlo Ct, Fort Polk, LA 71459 Phone: 805-857-1215 | |
Dr. Pamela Chan Kamolpechara, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 1840 Bell Richard Ave, Bldg 2157, Fort Polk, LA 71459 Phone: 337-531-4854 | |
Stephanie Dyane Thomas, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 7223 Mississippi Ave, Fort Polk, LA 71459 Phone: 337-531-4762 | |
Aaron Stoker, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 1585 3rd St, Fort Polk, LA 71459 Phone: 337-531-3832 | |
Dr. Malcolm Edward Thornton, D.M.D. Dentist Medicare: Not Enrolled in Medicare Practice Location: Fort Polk Dentac, 1585 3rd Street, Ste 6119a, Fort Polk, LA 71459 Phone: 337-531-4400 Fax: 337-531-4715 | |
Gregory Derose Jr., DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 7223 Mississippi Avenue, Bldg 1561, Fort Polk, LA 71459 Phone: 337-531-2603 |