Healthcare Provider Details

I. General information

NPI: 1225171135
Provider Name (Legal Business Name): BRYAN STEVEN CHRISTENSEN DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6243 S REDWOOD RD SUITE 100
SALT LAKE CITY UT
84123-6411
US

IV. Provider business mailing address

6243 S REDWOOD RD SUITE 100
SALT LAKE CITY UT
84123-6411
US

V. Phone/Fax

Practice location:
  • Phone: 801-269-1110
  • Fax: 801-269-0545
Mailing address:
  • Phone: 801-269-1110
  • Fax: 801-269-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6216924-9924
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: