Healthcare Provider Details

I. General information

NPI: 1801948922
Provider Name (Legal Business Name): CHRISTOPHER NORBERT MODJESKI DDS, CAGS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 SAN JOSE ST # 3
SALINAS CA
93901-3931
US

IV. Provider business mailing address

224 SAN JOSE ST # 3
SALINAS CA
93901-3931
US

V. Phone/Fax

Practice location:
  • Phone: 831-758-1672
  • Fax: 831-758-1137
Mailing address:
  • Phone: 831-758-1672
  • Fax: 831-758-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number53685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: