Provider Demographics
NPI:1457345134
Name:CHRISTENSEN, LYNDE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNDE
Middle Name:D
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 N CRESTMONT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2192
Mailing Address - Country:US
Mailing Address - Phone:208-887-7622
Mailing Address - Fax:208-887-7689
Practice Address - Street 1:1558 N CRESTMONT DR
Practice Address - Street 2:SUITE A
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2192
Practice Address - Country:US
Practice Address - Phone:208-887-7622
Practice Address - Fax:208-887-7689
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD37411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806834200Medicaid
ID806834200Medicaid