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General NPI Number Information
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NPI Number | 1740730704
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Entity Type | Organization
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Legal Business Name | SAMUEL W. CHRISTENSEN
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 390 S GREEN VALLEY RD STE 5
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City | WATSONVILLE
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State | CA
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Zip | 95076-3077
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Country | US
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Telephone | 831-722-1432
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Fax | 831-722-7861
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Provider Business Mailing Address
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Address Line | 390 S GREEN VALLEY RD STE 5
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City | WATSONVILLE
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State | CA
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Zip | 95076-3077
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Country | US
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Telephone | 831-722-1432
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Fax | 831-722-7861
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SAMUEL WESLEY CHRISTENSEN
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Credential | 53776
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Telephone | 831-722-1432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 53776
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License Number State | CA
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