Provider Demographics
NPI:1326121138
Name:JACK J. KLAUSNER DDS, PC
Entity Type:Organization
Organization Name:JACK J. KLAUSNER DDS, PC
Other - Org Name:BACK BAY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLAUSNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-247-9966
Mailing Address - Street 1:21 BAY STATE RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2101
Mailing Address - Country:US
Mailing Address - Phone:617-247-9096
Mailing Address - Fax:617-266-0679
Practice Address - Street 1:21 BAY STATE RROAD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-247-9966
Practice Address - Fax:617-266-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty