Provider Demographics
NPI:1982171708
Name:KLEMANN, NOELLE (DMD)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:KLEMANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 SE SUNNYSIDE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8468
Mailing Address - Country:US
Mailing Address - Phone:503-698-4884
Mailing Address - Fax:
Practice Address - Street 1:13110 SE SUNNYSIDE RD STE A
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8468
Practice Address - Country:US
Practice Address - Phone:503-698-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD110071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice