Provider Demographics
NPI:1174765978
Name:CHRISTENSEN, EVAN D (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:D
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W 70TH ST
Mailing Address - Street 2:APT. 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4534
Mailing Address - Country:US
Mailing Address - Phone:801-556-8815
Mailing Address - Fax:
Practice Address - Street 1:53 W 70TH ST
Practice Address - Street 2:APT. 5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4534
Practice Address - Country:US
Practice Address - Phone:801-556-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO23749001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics