Provider Demographics
NPI:1316395486
Name:KLASKO, SETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:KLASKO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 STONE PARK LN
Mailing Address - Street 2:APT 307
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-3175
Mailing Address - Country:US
Mailing Address - Phone:602-510-1308
Mailing Address - Fax:
Practice Address - Street 1:150 MORNING SUN DR
Practice Address - Street 2:SUITE 200W
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-9160
Practice Address - Country:US
Practice Address - Phone:719-387-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202842122300000X
CODEN.00202842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist