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General NPI Number Information
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NPI Number | 1689936049
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Entity Type | Organization
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Legal Business Name | KELDSEN FAMILY DENTAL CARE
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 600 NW HARRIMAN ST
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City | BEND
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State | OR
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Zip | 97701-2819
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Country | US
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Telephone | 541-389-0277
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Fax | 541-389-4731
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Provider Business Mailing Address
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Address Line | 600 NW HARRIMAN ST
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City | BEND
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State | OR
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Zip | 97701-2819
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Country | US
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Telephone | 541-389-0277
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Fax | 541-389-4731
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | CHRISTOPHER KELDSEN
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Credential | DMD
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Telephone | 541-389-0277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D8854
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License Number State | OR
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