Organization
SOUTHWAY ORTHODONTICS PLLC
Active
Other names
Christensen Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRET CHRISTENSEN DDS, MS (DR)
(208) 791-0428
Entity
Organization
Contact information
Practice address
77 SOUTHWAY AVE, SUITE D, LEWISTON, ID 83501-2203
(208) 798-4427
(208) 743-4807
Mailing address
77 SOUTHWAY AVE, SUITE D, LEWISTON, ID 83501-2203
(208) 798-4427
(208) 743-4807
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
D 3069 OR
ID
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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