Provider Demographics
NPI:1194837625
Name:CHRISTENSEN, KYLE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:S
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1268 W. SOUTH JORDAN PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4653
Mailing Address - Country:US
Mailing Address - Phone:801-561-8088
Mailing Address - Fax:801-561-8286
Practice Address - Street 1:1268 W. SOUTH JORDAN PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4653
Practice Address - Country:US
Practice Address - Phone:801-561-8088
Practice Address - Fax:801-561-8286
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT3703791223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU77294Medicare UPIN