Healthcare Provider Details

I. General information

NPI: 1851470264
Provider Name (Legal Business Name): M. TODD CHRISTENSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARVIN TODD CHRISTENSEN DMD

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S HIGLEY RD 103
GILBERT AZ
85296-1166
US

IV. Provider business mailing address

67 S HIGLEY RD 103
GILBERT AZ
85296-1166
US

V. Phone/Fax

Practice location:
  • Phone: 480-518-5502
  • Fax: 480-219-9234
Mailing address:
  • Phone: 480-518-5502
  • Fax: 480-219-9234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5604
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number5604
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: