Provider Demographics
NPI:1427540368
Name:KLUG, MARY KIRKPATRICK (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KIRKPATRICK
Last Name:KLUG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELISE
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3105 KIRBY WHITTEN RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1308 N KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3906
Practice Address - Country:US
Practice Address - Phone:405-216-5299
Practice Address - Fax:405-216-3358
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10775122300000X
OK7653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist