=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326143801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER R CHRISTENSEN DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6087 S REDWOOD RD SUITE C
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84123-5330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-838-8030
-----------------------------------------------------
Fax | 801-352-1872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4896 S 1900 W SUITE C
-----------------------------------------------------
City | ROY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84067-2994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-825-3898
-----------------------------------------------------
Fax | 801-352-1872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 135993
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------