Provider Demographics
NPI:1861663635
Name:CHRISTENSEN, GAVIN COTANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:COTANT
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 1:2648 E GERONIMO ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1210
Mailing Address - Country:US
Mailing Address - Phone:480-239-3757
Mailing Address - Fax:
Practice Address - Street 1:6750 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1127
Practice Address - Country:US
Practice Address - Phone:602-242-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9838133-99231223P0221X
AZD77261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry