Provider Demographics
NPI:1528180411
Name:KLEVANSKY, JON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:KLEVANSKY
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 1:3993 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2831
Mailing Address - Country:US
Mailing Address - Phone:770-921-1115
Mailing Address - Fax:770-564-3856
Practice Address - Street 1:3993 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 100A
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2831
Practice Address - Country:US
Practice Address - Phone:770-921-1115
Practice Address - Fax:770-564-3856
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA125901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice