Provider Demographics
NPI:1124621784
Name:KLOEK DENTISTRY LLC
Entity type:Organization
Organization Name:KLOEK DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-635-7888
Mailing Address - Street 1:W7154 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-8651
Mailing Address - Country:US
Mailing Address - Phone:715-635-7888
Mailing Address - Fax:715-635-6313
Practice Address - Street 1:W7154 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-8651
Practice Address - Country:US
Practice Address - Phone:715-635-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental