Provider Demographics
NPI:1053468306
Name:CHRISTENSEN, MICHAEL TED (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TED
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 1:560 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1800
Mailing Address - Country:US
Mailing Address - Phone:435-896-8282
Mailing Address - Fax:435-896-6443
Practice Address - Street 1:560 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1800
Practice Address - Country:US
Practice Address - Phone:435-896-8282
Practice Address - Fax:435-896-6443
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5924926-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist