Provider Demographics
NPI:1629040746
Name:CHRISTOPHERSON, EDWARD HELMUT (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HELMUT
Last Name:CHRISTOPHERSON
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 1:750 GEORGE WASHINGTON WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4247
Mailing Address - Country:US
Mailing Address - Phone:509-943-8616
Mailing Address - Fax:509-943-8617
Practice Address - Street 1:750 GEORGE WASHINGTON WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4247
Practice Address - Country:US
Practice Address - Phone:509-943-8616
Practice Address - Fax:509-943-8617
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000048361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5546809Medicaid
WAAC8758849OtherDEA NUMBER