Provider Demographics
NPI:1942950068
Name:BRAD CHRISTENSON DDS PC
Entity Type:Organization
Organization Name:BRAD CHRISTENSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-482-7660
Mailing Address - Street 1:350 JOHNSTOWN RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5365
Mailing Address - Country:US
Mailing Address - Phone:757-482-7660
Mailing Address - Fax:757-372-4226
Practice Address - Street 1:350 JOHNSTOWN RD STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5365
Practice Address - Country:US
Practice Address - Phone:757-482-7660
Practice Address - Fax:757-372-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty