Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5336153-9923 | UT |
N | 1223P0221X | Pediatric Dentist | 53361539923 | UT |
NPI | 1073627295 |
---|---|
Provider Name | Dr. Brett Kendall Christensen |
First Address | St George, UT 84790-7278 |
Second Address | St George, UT 84790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 10/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100506180 | (05) | NV |
1759539 | UNITED CONCORDIA (01) | |
53361539902001 | BXBS (01) | UT |
83041 | PEHP (01) | |
937807 | (05) | AZ |