Provider Demographics
NPI:1700091832
Name:CHRISTENSEN, TODD S (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:S
Last Name:CHRISTENSEN
Suffix:
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 1:5018 E 41 N
Mailing Address - Street 2:
Mailing Address - City:RIRIE
Mailing Address - State:ID
Mailing Address - Zip Code:83443-5038
Mailing Address - Country:US
Mailing Address - Phone:907-441-4569
Mailing Address - Fax:
Practice Address - Street 1:2101 E SUN MOUNTAIN AVE #107
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9965
Practice Address - Country:US
Practice Address - Phone:907-357-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist