MEDICARE: DR. KEVIN K CHRISTENSEN 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	4136	AR

General Provider Information

NPI Number	:	1508991365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN K CHRISTENSEN D.D.S.

Provider Business Mailing Address
First Line	:	1515 ROCK SPRINGS RD
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-8804
Country	:	US
Telephone Number	:	870-741-1060
Fax Number	:	870-741-4713

Provider Business Practice Location Address
First Line	:	1515 ROCK SPRINGS RD
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-8804
Country	:	US
Telephone Number	:	870-741-1060
Fax Number	:	870-741-4713

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/26/2019

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