Individual
DR. KIRK CHRISTIANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
511 SW 10TH AVE, SUITE 1114, PORTLAND, OR 97205-2712
(503) 228-4122
(503) 228-2036
Mailing address
511 SW 10TH AVE STE 1114, PORTLAND, OR 97205-2712
(503) 228-4122
(503) 228-2036
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
FC3623053
OR
1223G0001X
General Practice Dentistry
D9563
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568585594
NPI
OR
01
—
FC3623053
STATE LICENSE
OR
Enumeration date
04/06/2007
Last updated
07/21/2022
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