Provider Demographics
NPI:1629410006
Name:KLASINSKI, SARA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ANN
Last Name:KLASINSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 75TH ST
Mailing Address - Street 2:#102
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8383
Mailing Address - Country:US
Mailing Address - Phone:715-340-8060
Mailing Address - Fax:
Practice Address - Street 1:3380 S KINNICKINNIC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3159
Practice Address - Country:US
Practice Address - Phone:414-482-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7081-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice