Provider Demographics
NPI:1083606651
Name:KLITZKE, ALBERT ERNST (DDS)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:ERNST
Last Name:KLITZKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11717 CALLE TRUCKSESS
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4819
Mailing Address - Country:US
Mailing Address - Phone:619-670-6695
Mailing Address - Fax:
Practice Address - Street 1:8790 CUYAMACA ST STE E
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4295
Practice Address - Country:US
Practice Address - Phone:619-596-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist