Provider Demographics
NPI:1780083824
Name:CHRISTENSEN, BENJAMIN (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
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 1:5742 ADAMS AVE PKWY
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-7157
Mailing Address - Country:US
Mailing Address - Phone:801-621-3383
Mailing Address - Fax:801-475-4014
Practice Address - Street 1:5742 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-621-3383
Practice Address - Fax:801-475-4014
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9067932-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist