Provider Demographics
NPI:1831295294
Name:KLAMUT, KENNETH M (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:KLAMUT
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 1:129 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801
Mailing Address - Country:US
Mailing Address - Phone:540-432-1300
Mailing Address - Fax:540-438-0811
Practice Address - Street 1:129 UNIVERSITY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801
Practice Address - Country:US
Practice Address - Phone:540-432-1300
Practice Address - Fax:540-438-0811
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010070801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA041609OtherANTHEM
VA528289OtherUNITED CONCORDIA
VA041609OtherANTHEM