=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982879508
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AARON A. CHRISTENSEN, D.M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2008
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3550 HARRISON BLVD STE 1
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-2082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-627-1221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3550 HARRISON BLVD STE 1
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-2082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-627-1221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AARON ALLEN CHRISTENSEN
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 801-627-1221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 376282-9923
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------