Active NPI
Shaun Christensen, DMD
- Dentist
- Nampa, ID
National Provider Identifier
1568560712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D 3588
- Practice address
- 155 S Midland Blvd
Nampa, ID 83686-2601 - Phone
- (208) 466-7424
- Fax
- (208) 466-7512
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D 3588 | ID | Primary |
Addresses
Primary practice location
155 S Midland Blvd
Nampa, ID 83686-2601
Mailing address
155 S Midland Blvd
Nampa, ID 83686-2601
Phone (208) 466-7424
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806452800 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D 3588 | ID | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419033600000",
"number": "1568560712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 S MIDLAND BLVD",
"city": "NAMPA",
"state": "ID",
"postal_code": "836862601",
"telephone_number": "208-466-7424",
"fax_number": "208-466-7512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 S MIDLAND BLVD",
"city": "NAMPA",
"state": "ID",
"postal_code": "836862601",
"telephone_number": "208-466-7424",
"fax_number": "208-466-7512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHRISTENSEN",
"first_name": "SHAUN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2014-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ID",
"license": "D 3588",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806452800",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.