Provider Demographics
NPI:1033848122
Name:KALKSTEIN, JAKE SAMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:SAMUEL
Last Name:KALKSTEIN
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 1:1549 22ND ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1131
Mailing Address - Country:US
Mailing Address - Phone:703-628-5153
Mailing Address - Fax:
Practice Address - Street 1:450 SYNDICATE ST N STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4127
Practice Address - Country:US
Practice Address - Phone:651-254-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist