Provider Demographics
NPI:1205027695
Name:KENNETH M. KLAMUT, DDS, PC
Entity Type:Organization
Organization Name:KENNETH M. KLAMUT, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KLAMUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-432-1300
Mailing Address - Street 1:129 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3751
Mailing Address - Country:US
Mailing Address - Phone:540-432-1300
Mailing Address - Fax:540-438-0811
Practice Address - Street 1:129 UNIVERSITY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3751
Practice Address - Country:US
Practice Address - Phone:540-432-1300
Practice Address - Fax:540-438-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010070801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1831295294OtherNPI INDIVIDUAL
VA528289OtherUNITED CONCORDIA
VA041609OtherANTHEM
VA041609OtherANTHEM