Provider Demographics
NPI:1215414123
Name:CHRISTIANSEN, DEVIN LUKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:LUKE
Last Name:CHRISTIANSEN
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 1:3590 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5855
Mailing Address - Country:US
Mailing Address - Phone:801-725-0337
Mailing Address - Fax:
Practice Address - Street 1:3590 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5855
Practice Address - Country:US
Practice Address - Phone:801-725-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74931223P0300X
UT12196790-99241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics