Provider Demographics
NPI: | 1750795530 |
---|---|
Name: | KLETTER D.M.D & LEVINE D.D.S. PC |
Entity type: | Organization |
Organization Name: | KLETTER D.M.D & LEVINE D.D.S. PC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | HEIDI |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | HANNA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 518-630-5420 |
Mailing Address - Street 1: | 945 ROUTE 146 |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | CLIFTON PARK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12065-3649 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-630-5420 |
Mailing Address - Fax: | 518-630-5422 |
Practice Address - Street 1: | 983 ROUTE 146 |
Practice Address - Street 2: | |
Practice Address - City: | CLIFTON PARK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12065-3616 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-371-3333 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | KLETTER D.M.D & LEVINE D.D.S. PC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2014-06-19 |
Last Update Date: | 2014-07-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0300X | Dental Providers | Dentist | Periodontics | Group - Single Specialty |