Individual provider Active NPI

Christopher L Mjelde, DMD

  • General Practice Dentistry
  • Santa Barbara, CA
National Provider Identifier
1235217274
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
33811 Issued in CA
Practice address
2780 State St
Suite #2
Santa Barbara, CA 93105-5518
Phone
(805) 687-5669
Fax
(805) 687-1529
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 33811 CA Primary

Addresses

Primary practice location

2780 State St
Suite #2
Santa Barbara, CA 93105-5518

Mailing address

2780 State St
Suite #2
Santa Barbara, CA 93105-5518
Phone (805) 687-5669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150611000998 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3870814197

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33811CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Mark a Da Re DDS Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235217274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2780 STATE ST",
            "address_2": "SUITE #2",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931055518",
            "telephone_number": "805-687-5669",
            "fax_number": "805-687-1529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 STATE ST",
            "address_2": "SUITE #2",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931055518",
            "telephone_number": "805-687-5669",
            "fax_number": "805-687-1529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MJELDE",
        "first_name": "CHRISTOPHER",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "33811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Barbara, CA

Sources for this page

Verify at the official NPI Registry.