Provider Demographics
NPI:1093565103
Name:KLEMICK, DARIA
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:KLEMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 NJ-35
Mailing Address - Street 2:STE 240
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-4663
Mailing Address - Country:US
Mailing Address - Phone:732-739-1491
Mailing Address - Fax:
Practice Address - Street 1:2137 NJ-35
Practice Address - Street 2:STE 240
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-739-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0305500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist