Provider Demographics
NPI:1043421258
Name:CHRISTENSON, BRAD WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:WILLIAM
Last Name:CHRISTENSON
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 1:350 JOHNSTOWN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5365
Mailing Address - Country:US
Mailing Address - Phone:757-482-7660
Mailing Address - Fax:
Practice Address - Street 1:350 JOHNSTOWN RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5365
Practice Address - Country:US
Practice Address - Phone:757-482-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics