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General NPI Number Information
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NPI Number | 1598834582
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Entity Type | Organization
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Legal Business Name | ALLIANCE DENTAL CLINIC PC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 2308 BOX BUTTE AVE.
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City | ALLIANCE
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State | NE
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Zip | 69301-0586
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Country | US
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Telephone | 308-762-6354
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 586
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City | ALLIANCE
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State | NE
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Zip | 69301-0586
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Country | US
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Telephone | 308-762-6354
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY DEE CHRISTENSEN
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Credential | D.D.S.
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Telephone | 308-762-6354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4498
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License Number State | NE
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