Provider Demographics
NPI:1023200573
Name:D E CLECKNER JR. DDS PC
Entity Type:Organization
Organization Name:D E CLECKNER JR. DDS PC
Other - Org Name:DENNIS E. CLECKNER DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-340-3231
Mailing Address - Street 1:228 N LYNNHAVEN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7514
Mailing Address - Country:US
Mailing Address - Phone:757-340-3231
Mailing Address - Fax:757-340-3231
Practice Address - Street 1:228 N LYNNHAVEN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7514
Practice Address - Country:US
Practice Address - Phone:757-340-3231
Practice Address - Fax:757-340-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006439261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental