Provider Demographics
NPI:1841415833
Name:KLEVEN, JACQUELINE SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:SUE
Last Name:KLEVEN
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 1:2700 BROWN TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4182
Mailing Address - Country:US
Mailing Address - Phone:817-282-1331
Mailing Address - Fax:817-282-7171
Practice Address - Street 1:2700 BROWN TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4182
Practice Address - Country:US
Practice Address - Phone:817-282-1331
Practice Address - Fax:817-282-7171
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice