Provider Demographics
NPI:1649460585
Name:KELDSEN, CHRISTOPHER PEDER (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PEDER
Last Name:KELDSEN
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 1:600 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:
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:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD88541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice