Provider Demographics
NPI:1043323553
Name:CHRISTENSEN, CORY RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:RICHARD
Last Name:CHRISTENSEN
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 1:5677 HWY 95
Mailing Address - Street 2:
Mailing Address - City:FORT MOJAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6049
Mailing Address - Country:US
Mailing Address - Phone:928-788-0052
Mailing Address - Fax:928-788-0053
Practice Address - Street 1:5677 HWY 95
Practice Address - Street 2:
Practice Address - City:FORT MOJAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6049
Practice Address - Country:US
Practice Address - Phone:928-788-0052
Practice Address - Fax:928-788-0053
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist