MEDICARE: DR. RUSSEL KYLE CHRISTENSEN

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	1223E0200X	Endodontics	2769	NV

General Provider Information

NPI Number	:	1578673695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSEL KYLE CHRISTENSEN

Provider Business Mailing Address
First Line	:	2024 GLENVIEW DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6114
Country	:	US
Telephone Number	:	702-255-5778
Fax Number	:

Provider Business Practice Location Address
First Line	:	6655 W SAHARA AVE
Second Line	:	SUITE A-106
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0842
Country	:	US
Telephone Number	:	702-876-5800
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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