Healthcare Provider Details

I. General information

NPI: 1669662425
Provider Name (Legal Business Name): KYLE S CHRISTENSEN, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 W SOUTH JORDAN PKWY SUITE 200
SOUTH JORDAN UT
84095-4652
US

IV. Provider business mailing address

1268 W SOUTH JORDAN PKWY SUITE 200
SOUTH JORDAN UT
84095-4652
US

V. Phone/Fax

Practice location:
  • Phone: 801-561-8088
  • Fax: 801-562-8286
Mailing address:
  • Phone: 801-561-8088
  • Fax: 801-562-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: KYLE S CHRISTENSEN
Title or Position: OWNER
Credential: D.D.S.
Phone: 801-561-8088