MEDICARE: KJELD AAMODT DDS MS NY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1487434452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KJELD AAMODT DDS MS NY PC

Provider Business Mailing Address
First Line	:	605 MARKET ST STE 1200
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94105-3214
Country	:	US
Telephone Number	:	415-548-9145
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 W 19TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-4224
Country	:	US
Telephone Number	:	929-955-1669
Fax Number	:

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

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	10/05/2023

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