Healthcare Provider Details

I. General information

NPI: 1487434452
Provider Name (Legal Business Name): KJELD AAMODT DDS MS NY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W 19TH ST
NEW YORK NY
10011-4224
US

IV. Provider business mailing address

605 MARKET ST STE 1200
SAN FRANCISCO CA
94105-3214
US

V. Phone/Fax

Practice location:
  • Phone: 929-955-1669
  • Fax:
Mailing address:
  • Phone: 415-548-9145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KJELD AAMODT
Title or Position: COFOUNDER, CEO OF IMPRESS USA
Credential: DDS MS
Phone: 831-238-7285