Provider Demographics
NPI:1962547216
Name:CHRISTENOT, CLIFFORD RODNEY (LD)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:RODNEY
Last Name:CHRISTENOT
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35560 US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-8438
Mailing Address - Country:US
Mailing Address - Phone:406-293-7412
Mailing Address - Fax:
Practice Address - Street 1:35560 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-8438
Practice Address - Country:US
Practice Address - Phone:406-293-7412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000510110Medicaid