Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 376098 | UT |
NPI | 1003919358 |
---|---|
Provider Name | Dr. Kurt D Christensen |
First Address | Cottonwood Heights, UT 84093 |
Second Address | Murray, UT 84107-5546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00809488 | UNITED CONCORDIA (01) | UT |