Provider Demographics
NPI:1629451232
Name:KESHTKAR, ARDALAN (DDS)
Entity Type:Individual
Prefix:
First Name:ARDALAN
Middle Name:
Last Name:KESHTKAR
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: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:916-784-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist