Provider Demographics
NPI:1952987000
Name:SUN MOUNTAIN DENTAL CARE LLC
Entity Type:Organization
Organization Name:SUN MOUNTAIN DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-441-4569
Mailing Address - Street 1:5018 E 41 N
Mailing Address - Street 2:
Mailing Address - City:RIRIE
Mailing Address - State:ID
Mailing Address - Zip Code:83443-5038
Mailing Address - Country:US
Mailing Address - Phone:907-441-4569
Mailing Address - Fax:
Practice Address - Street 1:2101 E SUN MOUNTAIN AVE #107
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9965
Practice Address - Country:US
Practice Address - Phone:907-357-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental