Provider Demographics
NPI:1689936049
Name:KELDSEN FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:KELDSEN FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KELDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-389-0277
Mailing Address - Street 1:600 NW HARRIMAN ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2819
Mailing Address - Country:US
Mailing Address - Phone:541-389-0277
Mailing Address - Fax:541-389-4731
Practice Address - Street 1:600 NW HARRIMAN ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2819
Practice Address - Country:US
Practice Address - Phone:541-389-0277
Practice Address - Fax:541-389-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD88541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty