Provider Demographics
NPI:1306307004
Name:KLEEMAN, MICHAEL DAVID (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:KLEEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 GRASSLANDS CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1862
Mailing Address - Country:US
Mailing Address - Phone:631-275-4823
Mailing Address - Fax:
Practice Address - Street 1:7575 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5738
Practice Address - Country:US
Practice Address - Phone:303-238-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002054151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty