Provider Demographics
NPI:1982879508
Name:AARON A. CHRISTENSEN, D.M.D., INC.
Entity Type:Organization
Organization Name:AARON A. CHRISTENSEN, D.M.D., INC.
Other - Org Name:CHRISTENSEN PEDIATRIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-627-1221
Mailing Address - Street 1:3550 HARRISON BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2082
Mailing Address - Country:US
Mailing Address - Phone:801-627-1221
Mailing Address - Fax:
Practice Address - Street 1:3550 HARRISON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2082
Practice Address - Country:US
Practice Address - Phone:801-627-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376282-99231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528083485001Medicaid
01320903OtherTRICARE
ID806116300Medicaid
WY117449500Medicaid
528083485AACOtherEDUCATORS
UT03762829900001OtherBCBS