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NPI Code Detail

MEDICARE: DR. CODY CHRISTENSEN D.D.S.

MEDICARE: DR. CODY CHRISTENSEN D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)D1463SD

General Provider Information

NPI Number : 1205176401
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CODY CHRISTENSEN D.D.S.
Provider Business Mailing Address
First Line : 3415 5TH ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-7365
Country : US
Telephone Number : 801-616-1628
Fax Number :
Provider Business Practice Location Address
First Line : 3415 5TH ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-7365
Country : US
Telephone Number : 605-348-6818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2013
Last Update Date : 07/06/2025

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