Active NPI
Wayne Earl Christianson, DDS
- General Practice Dentistry
- Moorhead, MN
National Provider Identifier
1679531719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9145
- Practice address
- 1616 30TH Ave S
Moorhead, MN 56560-5152 - Phone
- (218) 233-4267
- NPI assigned
- May 1, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9145 | MN | Primary |
Addresses
Primary practice location
1616 30TH Ave S
Moorhead, MN 56560-5152
Mailing address
3611 Rivershore Dr
Moorhead, MN 56560-5556
Phone (218) 236-7697
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150602000626 | MN | Order and Referring Only - Other (Non-Physician) | 3072834100 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9145 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346803200000",
"number": "1679531719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3611 RIVERSHORE DR",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565605556",
"telephone_number": "218-236-7697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1616 30TH AVE S",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565605152",
"telephone_number": "218-233-4267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHRISTIANSON",
"first_name": "WAYNE",
"middle_name": "EARL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-01",
"last_updated": "2012-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "9145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.