Provider Demographics
NPI:1396003380
Name:CHRISTENSEN, BRANDON NEELEY (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:NEELEY
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1700 ALTA DR APT 1009
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4149
Mailing Address - Country:US
Mailing Address - Phone:801-830-8753
Mailing Address - Fax:
Practice Address - Street 1:401 EASTRIDGE CT
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6429
Practice Address - Country:US
Practice Address - Phone:404-778-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100166204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery