Provider Demographics
NPI:1447419866
Name:JACK D.KLURE, DDS PLLC
Entity Type:Organization
Organization Name:JACK D.KLURE, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLURE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-888-9399
Mailing Address - Street 1:110 E USTICK RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5502
Mailing Address - Country:US
Mailing Address - Phone:208-888-9399
Mailing Address - Fax:208-888-6115
Practice Address - Street 1:110 E USTICK RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5502
Practice Address - Country:US
Practice Address - Phone:208-888-9399
Practice Address - Fax:208-888-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty