Provider Demographics
NPI:1730616731
Name:STEFFENSON, CHRISTOPHER (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:STEFFENSON
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 1:836 LAKESHORE BLVD W
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-2801
Mailing Address - Country:US
Mailing Address - Phone:320-360-2967
Mailing Address - Fax:
Practice Address - Street 1:108 MICHIGAN AVE WEST
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484
Practice Address - Country:US
Practice Address - Phone:218-547-1854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice