Provider Demographics
NPI:1366627960
Name:LAKE PLEASANT ORTHODONTIC SPECIALISTS
Entity Type:Organization
Organization Name:LAKE PLEASANT ORTHODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:623-486-3377
Mailing Address - Street 1:10006 W HAPPY VALLEY RD
Mailing Address - Street 2:SUITE1220
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1235
Mailing Address - Country:US
Mailing Address - Phone:623-486-3377
Mailing Address - Fax:623-825-1987
Practice Address - Street 1:10006 W HAPPY VALLEY RD
Practice Address - Street 2:SUITE1220
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1235
Practice Address - Country:US
Practice Address - Phone:623-486-3377
Practice Address - Fax:623-825-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD56681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty