Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 137010-9921 | UT |
NPI | 1083788210 |
---|---|
Provider Name | Dr. Gordon J Christensen |
First Address | Provo, UT 84604-4592 |
Second Address | Provo, UT 84604-4592 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |