Provider Demographics
NPI:1003090200
Name:JEFFREY C KLEIMAN DMD PC
Entity Type:Organization
Organization Name:JEFFREY C KLEIMAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KLEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-974-4799
Mailing Address - Street 1:13660 N 94TH DR
Mailing Address - Street 2:E-3
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4209
Mailing Address - Country:US
Mailing Address - Phone:623-974-4799
Mailing Address - Fax:
Practice Address - Street 1:13660 N 94TH DR
Practice Address - Street 2:E-3
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4209
Practice Address - Country:US
Practice Address - Phone:623-974-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2450261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental