Provider Demographics
NPI:1770387508
Name:CHRISTENSEN, MISTY A (RDH, EFDA)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:A
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:RDH, EFDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13979 ROAD 25 SW
Mailing Address - Street 2:
Mailing Address - City:MATTAWA
Mailing Address - State:WA
Mailing Address - Zip Code:99349-7219
Mailing Address - Country:US
Mailing Address - Phone:509-688-3811
Mailing Address - Fax:
Practice Address - Street 1:601 GOVERNMENT RD
Practice Address - Street 2:
Practice Address - City:MATTAWA
Practice Address - State:WA
Practice Address - Zip Code:99349-5120
Practice Address - Country:US
Practice Address - Phone:509-688-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH70017850124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist