Provider Demographics
NPI:1235134503
Name:KLEMMEDSON, DANIEL JAMES (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:KLEMMEDSON
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3150 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1227
Mailing Address - Country:US
Mailing Address - Phone:520-745-6531
Mailing Address - Fax:520-790-3817
Practice Address - Street 1:3150 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1227
Practice Address - Country:US
Practice Address - Phone:520-745-6531
Practice Address - Fax:520-790-3817
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16321204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery