Healthcare Provider Details

I. General information

NPI: 1003919358
Provider Name (Legal Business Name): KURT D CHRISTENSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 E VINE ST 12
MURRAY UT
84107-5546
US

IV. Provider business mailing address

7948 S ASHLEY DOWNS CT
COTTONWOOD HEIGHTS UT
84093
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-1135
  • Fax: 801-685-7630
Mailing address:
  • Phone: 801-268-1135
  • Fax: 801-685-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number376098
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00809488
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerUNITED CONCORDIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: