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General NPI Number Information
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NPI Number | 1518366111
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Entity Type | Organization
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Legal Business Name | EAST VALLEY DENTAL ANESTHESIA, PLLC
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 67 S HIGLEY RD SUITE 103
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City | GILBERT
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State | AZ
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Zip | 85296-1166
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Country | US
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Telephone | 480-518-5502
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Fax | 480-219-9234
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Provider Business Mailing Address
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Address Line | 67 S HIGLEY RD SUITE 103
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City | GILBERT
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State | AZ
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Zip | 85296-1166
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Country | US
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Telephone | 480-518-5502
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Fax | 480-219-9234
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. MARVIN TODD CHRISTENSEN
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Credential | DMD
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Telephone | 480-518-5502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 5604
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License Number State | AZ
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