Provider Demographics
NPI:1851891964
Name:KLEEN DENTAL PLLC
Entity Type:Organization
Organization Name:KLEEN DENTAL PLLC
Other - Org Name:HARBOR POINT DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDYAVATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KONEGOWDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-495-3487
Mailing Address - Street 1:1076 ARCHES PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 W INTERSTATE 30 STE 610
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5799
Practice Address - Country:US
Practice Address - Phone:972-226-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental