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General NPI Number Information
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NPI Number | 1366627960
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Entity Type | Organization
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Legal Business Name | LAKE PLEASANT ORTHODONTIC SPECIALISTS
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 10006 W HAPPY VALLEY RD SUITE1220
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City | PEORIA
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State | AZ
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Zip | 85383-1235
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Country | US
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Telephone | 623-486-3377
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Fax | 623-825-1987
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Provider Business Mailing Address
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Address Line | 10006 W HAPPY VALLEY RD SUITE1220
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City | PEORIA
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State | AZ
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Zip | 85383-1235
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Country | US
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Telephone | 623-486-3377
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Fax | 623-825-1987
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Authorized Official
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Title or Position | ORTHODONTIST - OWNER
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Name | DR. TROY L. CHRISTENSEN
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Credential | DDS, MS
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Telephone | 623-486-3377
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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 | D5668
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License Number State | AZ
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