Provider Demographics
NPI:1235332719
Name:WAYNE J CHRISTIAN
Entity Type:Organization
Organization Name:WAYNE J CHRISTIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:435-628-4422
Mailing Address - Street 1:330 EAST TABERNACLE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-628-4422
Mailing Address - Fax:435-628-4458
Practice Address - Street 1:330 E TABERNACLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3093
Practice Address - Country:US
Practice Address - Phone:435-628-4422
Practice Address - Fax:435-628-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143292-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty