Provider Demographics
NPI:1235519018
Name:CHRISTENSEN, PATRICK D (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:D
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:D
Other - Last Name:CHRISTENEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2120 W GUADALUPE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7366
Mailing Address - Country:US
Mailing Address - Phone:480-839-0985
Mailing Address - Fax:480-730-8631
Practice Address - Street 1:2120 W GUADALUPE RD STE 5
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7366
Practice Address - Country:US
Practice Address - Phone:480-839-0985
Practice Address - Fax:480-730-8631
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist