Provider Demographics
NPI:1376589788
Name:KLOKOW, DAVID K (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:KLOKOW
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S BEACH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4404
Mailing Address - Country:US
Mailing Address - Phone:386-253-3413
Mailing Address - Fax:386-253-6002
Practice Address - Street 1:208 S BEACH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4404
Practice Address - Country:US
Practice Address - Phone:386-253-3413
Practice Address - Fax:386-253-6002
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN82031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice