Provider Demographics
NPI:1548425184
Name:KLEITCHES, TOM J
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:J
Last Name:KLEITCHES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ATHANASIAS
Other - Middle Name:J
Other - Last Name:KLEITCHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS,PA
Mailing Address - Street 1:518 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5353
Mailing Address - Country:US
Mailing Address - Phone:704-845-3008
Mailing Address - Fax:704-841-9437
Practice Address - Street 1:518 W JOHN ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5353
Practice Address - Country:US
Practice Address - Phone:704-845-3008
Practice Address - Fax:704-841-9437
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59881223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics