Healthcare Provider Details

I. General information

NPI: 1366742959
Provider Name (Legal Business Name): ANGELA LEE ANDERSON CHRISTENSEN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 W. PEACOCK MIDGE DR.
BLUFFDALE UT
84065
US

IV. Provider business mailing address

1234 W. PEACOCK MIDGE DR.
BLUFFDALE UT
84065
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-3610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5939598-8903
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: