Provider Demographics
NPI:1518042209
Name:KLASSON, STEVEN CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:KLASSON
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 1:334 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-7167
Mailing Address - Country:US
Mailing Address - Phone:207-873-9600
Mailing Address - Fax:207-873-5629
Practice Address - Street 1:334 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-7167
Practice Address - Country:US
Practice Address - Phone:207-873-9600
Practice Address - Fax:207-873-5629
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME117880000Medicaid