Provider Demographics
NPI:1962745471
Name:CHRISTENSEN, SAMUEL (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 N ANKENY BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4710
Mailing Address - Country:US
Mailing Address - Phone:515-965-2672
Mailing Address - Fax:
Practice Address - Street 1:2575 N ANKENY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4710
Practice Address - Country:US
Practice Address - Phone:515-965-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091751223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0221XDental ProvidersDentistPediatric Dentistry