Provider Demographics
NPI:1518510643
Name:ARDALAN KESHTKAR DDS INC
Entity Type:Organization
Organization Name:ARDALAN KESHTKAR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARDALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHTKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-784-0900
Mailing Address - Street 1:PO BOX 2202
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-7432
Mailing Address - Country:US
Mailing Address - Phone:916-915-3390
Mailing Address - Fax:
Practice Address - Street 1:10 SIERRA GATE PLZ STE 130
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6646
Practice Address - Country:US
Practice Address - Phone:916-872-0617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental