Healthcare Provider Details

I. General information

NPI: 1275742843
Provider Name (Legal Business Name): CHRISTOPHER SMITH LAURITZEN I DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/07/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELITE DENTAL PARTNERS 655 DEERWOOD AVE
NEENAH WI
54956-8276
US

IV. Provider business mailing address

ELITE DENTAL PARTNERS 655 DEERWOOD AVE
NEENAH WI
54956
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-8276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9738345-9921
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number600176415
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18239
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: