Provider Demographics
NPI:1184834905
Name:CHRISTENSEN, CHAD EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:EDWARD
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 SOUTH 2000 WEST
Mailing Address - Street 2:A
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075
Mailing Address - Country:US
Mailing Address - Phone:801-773-2366
Mailing Address - Fax:801-773-2691
Practice Address - Street 1:2475 E 1900 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-7815
Practice Address - Country:US
Practice Address - Phone:801-773-2366
Practice Address - Fax:801-773-2691
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4921979-99221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics