Drew James Christianson, MDT

Primary specialty

Advanced Practice Dental TherapistTaxonomy code 125K00000X

License

DT45 Issued in MN

Practice address

12936 63Rd Ave N
Maple Grove, MN 55369-6001

Phone

(763) 559-3400

NPI assigned

Jun 16, 2014

Last updated

Feb 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Al Shifa Dentistry PA

  • Dental Clinic/Center
  • Maple Grove, MN
  • NPI 1760703151
  NPD (past)

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1164836334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12936 63RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696001",
            "telephone_number": "763-559-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12936 63RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696001",
            "telephone_number": "763-559-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTIANSON",
        "first_name": "DREW",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "MDT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-16",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "MN",
            "license": "DT45",
            "primary": false
        },
        {
            "code": "125K00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Dental Therapist",
            "state": "MN",
            "license": "DT45",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Chong, MD, MPH
• Amy Chookiatsirichai
• Amy L.F. Chouinard, MA CCC-SLP
• Kennedy Christensen
• Tracy Christensen, OD
• Krystina R Christianson, LICSW
• Mikayla L Christianson, MA, LPCC
• Shannon M Christopherson, PA-C
• Mark Andrew Ciagne, M.D.
• Cich Chiropractic

• Advanced Practice Dental Therapist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Advanced Practice Dental Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.