=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275901456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TYLER M. CHRISTENSEN, DDS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2015
-----------------------------------------------------
Last Update Date | 09/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10521 JEFFREYS ST SUITE 200
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-4180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-331-2121
-----------------------------------------------------
Fax | 702-331-1616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10521 JEFFREYS ST SUITE 200
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-4180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-331-2121
-----------------------------------------------------
Fax | 702-331-1616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TYLER M CHRISTENSEN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 702-331-2121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4770
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------