Provider Demographics
NPI:1538447909
Name:EDWARD A. CHRISTENSEN, D.D.S., P.C.
Entity type:Organization
Organization Name:EDWARD A. CHRISTENSEN, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-604-9500
Mailing Address - Street 1:2750 E 136TH AVE
Mailing Address - Street 2:#100
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9107
Mailing Address - Country:US
Mailing Address - Phone:303-604-9500
Mailing Address - Fax:303-604-9540
Practice Address - Street 1:2750 E 136TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3530
Practice Address - Country:US
Practice Address - Phone:303-452-9502
Practice Address - Fax:720-583-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO76661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31453261Medicaid