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General NPI Number Information
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NPI Number | 1033532957
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Entity Type | Individual
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Provider Name | VICTOR KVIKSTAD DDS
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Gender | Male
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 3609 JAMISON WAY
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4303
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Country | US
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Telephone | 510-886-3888
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Fax | 510-881-0600
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Provider Business Mailing Address
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Address Line | 7220 MORTON PL
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City | CASTRO VALLEY
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State | CA
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Zip | 94552-5284
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Country | US
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Telephone | 510-517-9335
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Fax | 510-881-0600
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 21470
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License Number State | CA
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