MEDICARE: CHRISTENSEN ORTHODONTICS, LLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2008035682	MO

General Provider Information

NPI Number	:	1346479979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTENSEN ORTHODONTICS, LLC

Provider Business Mailing Address
First Line	:	7120 NW PRAIRIE VIEW RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-1630
Country	:	US
Telephone Number	:	816-741-1155
Fax Number	:

Provider Business Practice Location Address
First Line	:	7120 NW PRAIRIE VIEW RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-1630
Country	:	US
Telephone Number	:	816-741-1155
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID MAYO CHRISTENSEN
Credential	:	DMD, MS
Telephone Number	:	816-741-1155

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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