Healthcare Provider Details

I. General information

NPI: 1851443881
Provider Name (Legal Business Name): JONATHAN KRISTIANTO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 N MAIN ST
SALINAS CA
93906-5101
US

IV. Provider business mailing address

1556 N MAIN ST
SALINAS CA
93906-5101
US

V. Phone/Fax

Practice location:
  • Phone: 831-444-0882
  • Fax: 831-444-0891
Mailing address:
  • Phone: 831-444-0882
  • Fax: 831-444-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: