Provider Demographics
NPI:1124248505
Name:CHRISTENSEN, SHANE ROBERT (MS, DDS)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:ROBERT
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 S HOUSTOUN WARING CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-3956
Mailing Address - Country:US
Mailing Address - Phone:303-918-6682
Mailing Address - Fax:
Practice Address - Street 1:19700 E PARKER SQUARE DR
Practice Address - Street 2:SUITE 8
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7301
Practice Address - Country:US
Practice Address - Phone:303-918-6682
Practice Address - Fax:303-805-2998
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist