MEDICARE: EDWARD A. CHRISTENSEN, D.D.S, P.C.

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
1	1223P0221X	Pediatric Dentistry		CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720279193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD A. CHRISTENSEN, D.D.S, P.C.

Provider Business Mailing Address
First Line	:	1140 W SOUTH BOULDER RD STE 102
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8910
Country	:	US
Telephone Number	:	303-604-9500
Fax Number	:	303-604-9540

Provider Business Practice Location Address
First Line	:	1140 W SOUTH BOULDER RD STE 102
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8910
Country	:	US
Telephone Number	:	303-604-9500
Fax Number	:	303-604-9540

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KIMBER BARNEY
Credential	:
Telephone Number	:	303-604-9500

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	07/21/2022

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