Provider Demographics
NPI:1568879914
Name:CHRISTENSEN, DANE (DDS)
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:
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 1:1355 E HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1576
Mailing Address - Country:US
Mailing Address - Phone:509-488-5216
Mailing Address - Fax:509-488-9496
Practice Address - Street 1:1355 E HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1576
Practice Address - Country:US
Practice Address - Phone:509-488-5216
Practice Address - Fax:509-488-9496
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE604668771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice