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General NPI Number Information
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NPI Number | 1790899409
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Entity Type | Organization
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Legal Business Name | SHAUN CHRISTENSEN, DMD, PC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 155 S MIDLAND BLVD
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City | NAMPA
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State | ID
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Zip | 83686-2601
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Country | US
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Telephone | 208-466-7424
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Fax | 208-466-7512
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Provider Business Mailing Address
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Address Line | 155 S MIDLAND BLVD
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City | NAMPA
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State | ID
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Zip | 83686-2601
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Country | US
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Telephone | 208-466-7424
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Fax | 208-466-7512
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | SHAUN CHRISTENSEN
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Credential | DMD
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Telephone | 208-466-7424
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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 | D3588
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License Number State | ID
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