Individual provider Active NPI

Gordon J Christensen, DDS

  • Prosthodontics
  • Provo, UT
National Provider Identifier
1083788210
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
137010-9921 Issued in UT
Practice address
3707 N Canyon Rd
Suite 3a
Provo, UT 84604-4592
Phone
(801) 226-5315
Fax
(801) 226-8637
NPI assigned
Nov 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 137010-9921 UT Primary

Addresses

Primary practice location

3707 N Canyon Rd
Suite 3a
Provo, UT 84604-4592

Mailing address

3707 N Canyon Rd
Suite 3a
Provo, UT 84604-4592
Phone (801) 226-5315

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160422001622 UT Order and Referring Only - DentistPractitioner - Dentist 8022317205

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083788210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 N CANYON RD",
            "address_2": "SUITE 3A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044592",
            "telephone_number": "801-226-5315",
            "fax_number": "801-226-8637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 N CANYON RD",
            "address_2": "SUITE 3A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044592",
            "telephone_number": "801-226-5315",
            "fax_number": "801-226-8637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTENSEN",
        "first_name": "GORDON",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "UT",
            "license": "137010-9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.