Provider Demographics
NPI:1033532957
Name:KVIKSTAD, VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:KVIKSTAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 MORTON PL
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5284
Mailing Address - Country:US
Mailing Address - Phone:510-517-9335
Mailing Address - Fax:510-881-0600
Practice Address - Street 1:3609 JAMISON WAY
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4303
Practice Address - Country:US
Practice Address - Phone:510-886-3888
Practice Address - Fax:510-881-0600
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist