Provider Demographics
NPI:1346479979
Name:CHRISTENSEN ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:CHRISTENSEN ORTHODONTICS, LLC
Other - Org Name:CHRISTENSEN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MAYO
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:816-741-1155
Mailing Address - Street 1:7120 NW PRAIRIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1630
Mailing Address - Country:US
Mailing Address - Phone:816-741-1155
Mailing Address - Fax:
Practice Address - Street 1:7120 NW PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1630
Practice Address - Country:US
Practice Address - Phone:816-741-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080356821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty