Healthcare Provider Details

I. General information

NPI: 1992327431
Provider Name (Legal Business Name): RYANN MICHELLE CHRISTENSEN, DDS, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 E HERNDON AVE STE 105
FRESNO CA
93720-3377
US

IV. Provider business mailing address

1642 E HERNDON AVE STE 105
FRESNO CA
93720-3377
US

V. Phone/Fax

Practice location:
  • Phone: 559-261-2055
  • Fax:
Mailing address:
  • Phone: 559-261-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RYANN CHRISTENSEN
Title or Position: PRESIDENT/ ORTHODONTIST
Credential: DDS, MS
Phone: 559-301-4597