Provider Demographics
NPI:1679567242
Name:CHRISTIANSEN, STEPHEN H (DDS)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:H
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4801 MCMAHON BLVD NW
Mailing Address - Street 2:#230
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5090
Mailing Address - Country:US
Mailing Address - Phone:505-792-4788
Mailing Address - Fax:505-792-2533
Practice Address - Street 1:4801 MCMAHON BLVD NW
Practice Address - Street 2:#230
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5090
Practice Address - Country:US
Practice Address - Phone:505-792-4788
Practice Address - Fax:505-792-2533
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD18891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ4365Medicaid
NMQ4365Medicaid