Healthcare Provider Details

I. General information

NPI: 1700703378
Provider Name (Legal Business Name): JAMES CLARK CHRISTIANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CHESTNUT DR STE 200
CHEYENNE WY
82001-5365
US

IV. Provider business mailing address

5221 BOULDER CT
CHEYENNE WY
82009-5575
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-8071
  • Fax:
Mailing address:
  • Phone: 720-448-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1731
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: