Provider Demographics
NPI:1083630727
Name:KLINKEFUS, DEBORAH LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LEE
Last Name:KLINKEFUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-1302
Mailing Address - Country:US
Mailing Address - Phone:480-834-1918
Mailing Address - Fax:480-834-1919
Practice Address - Street 1:30 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1302
Practice Address - Country:US
Practice Address - Phone:480-834-1918
Practice Address - Fax:480-834-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice