Provider Demographics
NPI:1548340433
Name:CHRISTENSEN, MARK DWAYNE SR (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DWAYNE
Last Name:CHRISTENSEN
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6617 PRECINCT LINE RD, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182
Mailing Address - Country:US
Mailing Address - Phone:817-595-2458
Mailing Address - Fax:817-590-2468
Practice Address - Street 1:6617 PRECINCT LINE RD, SUITE 100
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182
Practice Address - Country:US
Practice Address - Phone:817-595-2458
Practice Address - Fax:817-590-2468
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice