Healthcare Provider Details

I. General information

NPI: 1669970034
Provider Name (Legal Business Name): JORDAN MILES CHRISTENSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 US-89 SUITE 100
PLEASANT VIEW UT
84404
US

IV. Provider business mailing address

1402 CAMP RD APT 5G
CHARLESTON SC
29412-3711
US

V. Phone/Fax

Practice location:
  • Phone: 801-782-5792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10398139-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: