Provider Demographics
NPI:1225171135
Name:CHRISTENSEN, BRYAN STEVEN (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:STEVEN
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6243 S REDWOOD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6411
Mailing Address - Country:US
Mailing Address - Phone:801-269-1110
Mailing Address - Fax:801-269-0545
Practice Address - Street 1:6243 S REDWOOD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-6411
Practice Address - Country:US
Practice Address - Phone:801-269-1110
Practice Address - Fax:801-269-0545
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6216924-99241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery