Provider Demographics
NPI:1235217274
Name:MJELDE, CHRISTOPHER L (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:L
Last Name:MJELDE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 STATE ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5518
Mailing Address - Country:US
Mailing Address - Phone:805-687-5669
Mailing Address - Fax:805-687-1529
Practice Address - Street 1:2780 STATE ST
Practice Address - Street 2:SUITE #2
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5518
Practice Address - Country:US
Practice Address - Phone:805-687-5669
Practice Address - Fax:805-687-1529
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice