Provider Demographics
NPI:1619927092
Name:KLESTINSKE, CHARLES H (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:KLESTINSKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:KS
Mailing Address - Zip Code:66018
Mailing Address - Country:US
Mailing Address - Phone:913-583-3233
Mailing Address - Fax:913-585-1510
Practice Address - Street 1:32980 W 83RD STREET
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:KS
Practice Address - Zip Code:66018
Practice Address - Country:US
Practice Address - Phone:913-583-3233
Practice Address - Fax:913-585-1510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice