Individual
JOHN CLARK CHRISTIANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2120 LOGAN AVE, CHEYENNE, WY 82001-4131
(307) 638-8071
Mailing address
9085 E MINERAL CIR STE 160, CENTENNIAL, CO 80112-3499
(303) 790-9323
(303) 792-5727
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
00205130
CO
1223G0001X
General Practice Dentistry
Primary
1639
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00205130
DENTIS
CO
Enumeration date
05/31/2022
Last updated
10/02/2023
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