Provider Demographics
NPI:1093164139
Name:MAGGIE A KLEEM DDS LLC
Entity Type:Organization
Organization Name:MAGGIE A KLEEM DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-239-8389
Mailing Address - Street 1:352 W BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1348
Mailing Address - Country:US
Mailing Address - Phone:440-239-8389
Mailing Address - Fax:
Practice Address - Street 1:352 W BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1348
Practice Address - Country:US
Practice Address - Phone:440-239-8389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGGIE A KLEEM DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-021064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1740335595OtherDENTIST