Provider Demographics
NPI:1568623163
Name:KLOTZ, MICHAEL W (DMD, MDENTSC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:KLOTZ
Suffix:
Gender:M
Credentials:DMD, MDENTSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WARREN AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1581
Mailing Address - Country:US
Mailing Address - Phone:201-444-9777
Mailing Address - Fax:201-612-0423
Practice Address - Street 1:312 WARREN AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1581
Practice Address - Country:US
Practice Address - Phone:201-444-9777
Practice Address - Fax:201-612-0423
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024506001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics