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General NPI Number Information
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NPI Number | 1184854390
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Entity Type | Organization
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Legal Business Name | CHRISTENSEN ORTHODONTICS, LLC
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 400 JULES ST STE 440
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City | SAINT JOSEPH
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State | MO
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Zip | 64501-1774
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Country | US
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Telephone | 816-364-1911
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Fax |
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Provider Business Mailing Address
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Address Line | 400 JULES ST STE 440
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City | SAINT JOSEPH
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State | MO
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Zip | 64501-1774
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Country | US
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Telephone | 816-364-1911
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DAVID M CHRISTENSEN
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Credential | DMD, MS
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Telephone | 816-364-1911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2008035682
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License Number State | MO
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