Provider Demographics
NPI:1679762728
Name:CHRISTIANSEN, DONALD RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RICHARD
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7228 E PAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-9795
Mailing Address - Country:US
Mailing Address - Phone:702-358-9987
Mailing Address - Fax:
Practice Address - Street 1:3285 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7000
Practice Address - Country:US
Practice Address - Phone:480-397-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6143122300000X
AZ7323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist