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NPI Code Detail

MEDICARE: DR. BRAD WILLIAM CHRISTENSON D.D.S.

MEDICARE:  DR. BRAD WILLIAM CHRISTENSON  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry0401410989VA

General Provider Information

NPI Number : 1043421258
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRAD WILLIAM CHRISTENSON D.D.S.
Provider Business Mailing Address
First Line : 350 JOHNSTOWN RD
Second Line : SUITE B
City : CHESAPEAKE
State : VA
Zip : 23322-5365
Country : US
Telephone Number : 757-482-7660
Fax Number :
Provider Business Practice Location Address
First Line : 350 JOHNSTOWN RD
Second Line : SUITE B
City : CHESAPEAKE
State : VA
Zip : 23322-5365
Country : US
Telephone Number : 757-482-7660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2007
Last Update Date : 07/08/2007

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