Provider Demographics
NPI:1508991365
Name:CHRISTENSEN, KEVIN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:K
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-8804
Mailing Address - Country:US
Mailing Address - Phone:870-741-1060
Mailing Address - Fax:870-741-4713
Practice Address - Street 1:1515 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-8804
Practice Address - Country:US
Practice Address - Phone:870-741-1060
Practice Address - Fax:870-741-4713
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR41361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice