Provider Demographics
NPI:1093204638
Name:PATRICK D. CHRISTENSEN, P.L.L.C.
Entity Type:Organization
Organization Name:PATRICK D. CHRISTENSEN, P.L.L.C.
Other - Org Name:FIRST IMPRESSION DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MA
Authorized Official - Phone:480-839-0985
Mailing Address - Street 1:2120 W GUADALUPE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7366
Mailing Address - Country:US
Mailing Address - Phone:480-839-0985
Mailing Address - Fax:480-730-8631
Practice Address - Street 1:2120 W GUADALUPE RD STE 5
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7366
Practice Address - Country:US
Practice Address - Phone:480-839-0985
Practice Address - Fax:480-730-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009232261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental