Provider Demographics
NPI:1053151936
Name:ST. ROMAIN, CHRISTIAN B (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:B
Last Name:ST. ROMAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-1523
Mailing Address - Country:US
Mailing Address - Phone:337-478-3123
Mailing Address - Fax:
Practice Address - Street 1:715 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1523
Practice Address - Country:US
Practice Address - Phone:337-478-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist