Provider Demographics
NPI:1508299280
Name:KLEIDOSTY, SUMMER AMR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:AMR
Last Name:KLEIDOSTY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 COURT ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1709
Mailing Address - Country:US
Mailing Address - Phone:775-384-1500
Mailing Address - Fax:775-871-2711
Practice Address - Street 1:436 COURT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501
Practice Address - Country:US
Practice Address - Phone:775-384-1500
Practice Address - Fax:775-871-2711
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV63421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice