Healthcare Provider Details

I. General information

NPI: 1073627295
Provider Name (Legal Business Name): BRETT KENDALL CHRISTENSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 E RIVERSIDE DR STE 6
ST GEORGE UT
84790
US

IV. Provider business mailing address

368 E RIVERSIDE DR STE 6
ST GEORGE UT
84790-7278
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-8827
  • Fax: 435-688-8826
Mailing address:
  • Phone: 435-688-8827
  • Fax: 435-688-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5336153-9923
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number53361539923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: