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Individual

KYLE CHRISTENSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648
(208) 828-7297
Mailing address
90 HOPE DR BLDG 6000, MTN HOME AFB, ID 83648-1062
(208) 828-7297

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4727
ID

Other

Enumeration date
10/08/2014
Last updated
05/22/2018
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