Provider Demographics
NPI:1790828606
Name:CHRISTENSEN, EDWARD H (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
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 1:2855 E BROWN RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-4214
Mailing Address - Country:US
Mailing Address - Phone:480-659-5977
Mailing Address - Fax:480-219-0971
Practice Address - Street 1:2855 E BROWN RD STE 5
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-4214
Practice Address - Country:US
Practice Address - Phone:480-659-5977
Practice Address - Fax:480-219-0971
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ79571223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery