Healthcare Provider Details

I. General information

NPI: 1528175296
Provider Name (Legal Business Name): ERIC CARL CHRISTENSEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CLARK HTS
PLEASANT VALLEY NY
12569-7757
US

IV. Provider business mailing address

PO BOX 634 7 CLARK HEIGHTS
PLEASANT VALLEY NY
12569-0634
US

V. Phone/Fax

Practice location:
  • Phone: 845-635-8158
  • Fax: 845-635-1539
Mailing address:
  • Phone: 845-635-8158
  • Fax: 845-635-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number049939
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: