Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5700-015 | WI |
NPI | 1194824342 |
---|---|
Provider Name | Dr. Loren Christensen |
First Address | Onalaska, WI 54650-2408 |
Second Address | Onalaska, WI 54650-2408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |