Provider Demographics
NPI:1033660725
Name:KLENKE & ASSOCIATES, PA
Entity Type:Organization
Organization Name:KLENKE & ASSOCIATES, PA
Other - Org Name:WEST AVENUE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:210-877-2273
Mailing Address - Street 1:11115 WURZBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2643
Mailing Address - Country:US
Mailing Address - Phone:210-877-2273
Mailing Address - Fax:210-561-5500
Practice Address - Street 1:12251 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2518
Practice Address - Country:US
Practice Address - Phone:210-342-6734
Practice Address - Fax:210-375-1396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLENKE & ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental