Provider Demographics
NPI:1689700098
Name:KJK ORTHODONTICS PC
Entity Type:Organization
Organization Name:KJK ORTHODONTICS PC
Other - Org Name:KLATTE ORTHODONTICS ASSOCIATED ORTHODONTISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KLATTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-745-9443
Mailing Address - Street 1:6814 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2106
Mailing Address - Country:US
Mailing Address - Phone:215-745-9443
Mailing Address - Fax:215-745-9453
Practice Address - Street 1:6814 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2106
Practice Address - Country:US
Practice Address - Phone:215-745-9443
Practice Address - Fax:215-745-9453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030955L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty