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General NPI Number Information
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NPI Number | 1669012860
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Entity Type | Organization
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Legal Business Name | KJELD AAMODT DDS MS IL PC
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 11 E CEDAR ST
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 415-653-3087
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Fax |
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Provider Business Mailing Address
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Address Line | 999 SUTTER ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-6023
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Country | US
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Telephone | 831-238-7285
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KJELD AAMODT
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Credential | DDS MS
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Telephone | 831-238-7285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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