Provider Demographics
NPI:1114295854
Name:KLIM, JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KLIM
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 1:2755 MENDOCINO AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2827
Mailing Address - Country:US
Mailing Address - Phone:707-546-4582
Mailing Address - Fax:707-546-1402
Practice Address - Street 1:2755 MENDOCINO AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2827
Practice Address - Country:US
Practice Address - Phone:707-546-4582
Practice Address - Fax:707-546-1402
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice