Provider Demographics
NPI:1922105790
Name:KJELDSEN, CHRISTIAN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:JAMES
Last Name:KJELDSEN
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 1:1128 B ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4055
Mailing Address - Country:US
Mailing Address - Phone:707-765-6021
Mailing Address - Fax:707-765-0894
Practice Address - Street 1:1128 B ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4055
Practice Address - Country:US
Practice Address - Phone:707-765-6021
Practice Address - Fax:707-765-0894
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice