Provider Demographics
NPI:1184670093
Name:KLINGER, BRENT J (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:J
Last Name:KLINGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1175 COOK RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118
Mailing Address - Country:US
Mailing Address - Phone:803-534-5444
Mailing Address - Fax:803-531-3668
Practice Address - Street 1:1175 COOK RD
Practice Address - Street 2:SUITE 135
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118
Practice Address - Country:US
Practice Address - Phone:803-534-5444
Practice Address - Fax:803-531-3668
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1697204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZZ1697Medicaid