Provider Demographics
NPI:1720307259
Name:CHRISTENSEN FAMILY DENTISTRY
Entity type:Organization
Organization Name:CHRISTENSEN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-670-9090
Mailing Address - Street 1:560 N STAPLEY DR
Mailing Address - Street 2:STE 2
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-7320
Mailing Address - Country:US
Mailing Address - Phone:480-964-2131
Mailing Address - Fax:480-964-7334
Practice Address - Street 1:560 N STAPLEY DR
Practice Address - Street 2:STE 2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-7320
Practice Address - Country:US
Practice Address - Phone:480-964-2131
Practice Address - Fax:480-964-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty