Provider Demographics
NPI:1003093717
Name:CHRISTIANSEN, RICHARD KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEVIN
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18200 BLANCO SPGS
Mailing Address - Street 2:420
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4560
Mailing Address - Country:US
Mailing Address - Phone:719-963-7874
Mailing Address - Fax:
Practice Address - Street 1:11398 BANDERA RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6841
Practice Address - Country:US
Practice Address - Phone:210-543-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85941223G0001X
TX25235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice