# CHRISTENSEN DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104099118
- **Authorized official:** DR. LYNDE D CHRISTENSEN DDS (DENTIST/OWNER)
- **Authorized official phone:** (208) 455-1816

## Contact information

- **Practice address:** 4111 CLOCK TOWER AVE, CALDWELL, ID 83607-5006
- **Practice address phone:** (208) 455-1816
- **Practice address fax:** (208) 459-1446
- **Mailing address:** 4111 CLOCK TOWER AVE, CALDWELL, ID 83607-5006
- **Mailing address phone:** (208) 455-1816
- **Mailing address fax:** (208) 459-1446

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3741 | ID | Yes |

## Other

- **Enumeration date:** 04/10/2008
- **Last updated:** 04/10/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6K588 | BLUE CROSS | ID |