Provider Demographics
NPI:1083106553
Name:CHRISTOPHERSON, ABBEY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABBEY
Middle Name:LYNN
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W FLORIDA ST APT 602
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1567
Mailing Address - Country:US
Mailing Address - Phone:414-791-3552
Mailing Address - Fax:
Practice Address - Street 1:2860 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4962
Practice Address - Country:US
Practice Address - Phone:262-955-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist