Provider Demographics
NPI:1063636801
Name:CHRISTIANSEN, HAROLD R
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:R
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 S PARKER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1623
Mailing Address - Country:US
Mailing Address - Phone:303-750-2460
Mailing Address - Fax:303-750-2463
Practice Address - Street 1:2530 S PARKER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1623
Practice Address - Country:US
Practice Address - Phone:303-750-2460
Practice Address - Fax:303-750-2463
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice