Provider Demographics
NPI:1316021439
Name:KLIEWER, KENNETH JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JOHN
Last Name:KLIEWER
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 1:525 LEONA LANE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-0353
Mailing Address - Country:US
Mailing Address - Phone:706-865-0382
Mailing Address - Fax:877-811-4753
Practice Address - Street 1:471 S MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1409
Practice Address - Country:US
Practice Address - Phone:706-865-0382
Practice Address - Fax:877-811-4753
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0094441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice