Provider Demographics
NPI:1912450297
Name:CHRISTENSEN, GREGORY WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WAYNE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 9TH ST W
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1505
Mailing Address - Country:US
Mailing Address - Phone:701-324-4180
Mailing Address - Fax:701-324-4702
Practice Address - Street 1:118 9TH ST W
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341
Practice Address - Country:US
Practice Address - Phone:701-324-4180
Practice Address - Fax:701-324-4702
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND23721223G0001X
MT21611223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health