Provider Demographics
NPI:1326873464
Name:KLEVENBERG, ANGELA M (DENTAL HYGIENIST)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:KLEVENBERG
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33533 W 12 MILE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-5600
Mailing Address - Country:US
Mailing Address - Phone:855-408-6650
Mailing Address - Fax:
Practice Address - Street 1:33533 W 12 MILE RD STE 150
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-5600
Practice Address - Country:US
Practice Address - Phone:855-408-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60093521124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist