Provider Demographics
NPI:1164043147
Name:ROSSIGNOL, KJETIL CHRISTIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:KJETIL
Middle Name:CHRISTIAN
Last Name:ROSSIGNOL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2004
Mailing Address - Country:US
Mailing Address - Phone:207-540-4440
Mailing Address - Fax:
Practice Address - Street 1:14 ACCESS HWY STE 4
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3895
Practice Address - Country:US
Practice Address - Phone:207-492-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME48671223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program