Provider Demographics
NPI:1275781791
Name:CHRISTIANSEN, KRISTIN M (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25521 EAST SMOKY HILL ROAD, SUITE #210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016
Mailing Address - Country:US
Mailing Address - Phone:303-617-5437
Mailing Address - Fax:
Practice Address - Street 1:25521 E SMOKY HILL RD UNIT 210
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1346
Practice Address - Country:US
Practice Address - Phone:303-617-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905700124Q00000X
CO002030671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid