Provider Demographics
NPI:1508553793
Name:CHRISTENSEN, MCKAY M (DMD)
Entity Type:Individual
Prefix:
First Name:MCKAY
Middle Name:M
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W OWEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2694
Mailing Address - Country:US
Mailing Address - Phone:385-312-4411
Mailing Address - Fax:
Practice Address - Street 1:2276 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2636
Practice Address - Country:US
Practice Address - Phone:435-359-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13365962-8903122300000X
UT13365962-9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist