Provider Demographics
NPI:1295343119
Name:CHRISTENSEN PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:CHRISTENSEN PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-440-5714
Mailing Address - Street 1:6908 S LYNCREST PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2565
Mailing Address - Country:US
Mailing Address - Phone:605-275-5771
Mailing Address - Fax:
Practice Address - Street 1:6908 S LYNCREST PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2565
Practice Address - Country:US
Practice Address - Phone:605-275-5771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABC PEDIATRIC DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-16
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty