MEDICARE: MR. STEPHEN H 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DD1889	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679567242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN H CHRISTIANSEN DDS

Provider Business Mailing Address
First Line	:	4801 MCMAHON BLVD NW
Second Line	:	#230
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5090
Country	:	US
Telephone Number	:	505-792-4788
Fax Number	:	505-792-2533

Provider Business Practice Location Address
First Line	:	4801 MCMAHON BLVD NW
Second Line	:	#230
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5090
Country	:	US
Telephone Number	:	505-792-4788
Fax Number	:	505-792-2533

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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