Healthcare Provider Details

I. General information

NPI: 1578673695
Provider Name (Legal Business Name): DR. RUSSEL KYLE CHRISTENSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 W SAHARA AVE SUITE A-106
LAS VEGAS NV
89146-0842
US

IV. Provider business mailing address

2024 GLENVIEW DR
LAS VEGAS NV
89134-6114
US

V. Phone/Fax

Practice location:
  • Phone: 702-876-5800
  • Fax:
Mailing address:
  • Phone: 702-255-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2769
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: