MEDICARE: MR. DOUGLAS N CHRISTIANSEN DDS

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	30889	CA

General Provider Information

NPI Number	:	1205867066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS N CHRISTIANSEN DDS

Provider Business Mailing Address
First Line	:	3737 MORAGA AVE
Second Line	:	B-400
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5404
Country	:	US
Telephone Number	:	858-274-8900
Fax Number	:	858-274-8982

Provider Business Practice Location Address
First Line	:	3737 MORAGA AVE
Second Line	:	B-400
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5404
Country	:	US
Telephone Number	:	858-274-8900
Fax Number	:	858-274-8982

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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