Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 21923 | TX |
Y | 1223P0300X | Periodontist | 260078 | NC |
NPI | 1063683092 |
---|---|
Provider Name | Dr. Christopher Joseph Vankesteren |
First Address | Charlotte, NC 28262-2577 |
Second Address | Charlotte, NC 28262-2577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2008 |
Last Update Date | 18/03/2008 |