MEDICARE: DANIEL GARY CHRISTIANSEN 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
1	1223G0001X	General Practice Dentistry	8653	CO

General Provider Information

NPI Number	:	1093717910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL GARY CHRISTIANSEN D.D.S.

Provider Business Mailing Address
First Line	:	10240 W 26TH AVE
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1487
Country	:	US
Telephone Number	:	303-232-4928
Fax Number	:	303-232-4929

Provider Business Practice Location Address
First Line	:	10240 W 26TH AVE
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1487
Country	:	US
Telephone Number	:	303-232-4928
Fax Number	:	303-232-4929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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