Healthcare Provider Details

I. General information

NPI: 1073431011
Provider Name (Legal Business Name): DR. CHRISTIAN CHIDESTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 LONETREE BLVD
ROCKLIN CA
95765-5874
US

IV. Provider business mailing address

611 BROOKLYN CT
LINCOLN CA
95648-7887
US

V. Phone/Fax

Practice location:
  • Phone: 916-884-5086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: