Provider Demographics
NPI:1801948922
Name:MODJESKI, CHRISTOPHER NORBERT (DDS, CAGS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:NORBERT
Last Name:MODJESKI
Suffix:
Gender:M
Credentials:DDS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 SAN JOSE ST # 3
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3931
Mailing Address - Country:US
Mailing Address - Phone:831-758-1672
Mailing Address - Fax:831-758-1137
Practice Address - Street 1:224 SAN JOSE ST # 3
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3931
Practice Address - Country:US
Practice Address - Phone:831-758-1672
Practice Address - Fax:831-758-1137
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics