Provider Demographics
NPI:1013165067
Name:CHRISTENSEN, DAVID MAYO (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MAYO
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 NW 86TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-2326
Mailing Address - Country:US
Mailing Address - Phone:816-741-1155
Mailing Address - Fax:
Practice Address - Street 1:7111 NW 86TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-2326
Practice Address - Country:US
Practice Address - Phone:816-741-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4475122300000X
SC7001223X0400X
MO20080356821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist