Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 4475 | SC |
Y | 1223X0400X | Orthodontists | 2008035682 | MO |
N | 1223X0400X | Orthodontists | 700 | SC |
NPI | 1013165067 |
---|---|
Provider Name | Dr. David Mayo Christensen |
First Address | Kansas City, MO 64153-2326 |
Second Address | Kansas City, MO 64153-2326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 19/04/2011 |