Provider Demographics
NPI:1871852392
Name:KLABO, CHRISTOPHER GORDON (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GORDON
Last Name:KLABO
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 1:25477 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-5001
Mailing Address - Country:US
Mailing Address - Phone:218-963-6330
Mailing Address - Fax:
Practice Address - Street 1:25477 MAIN ST
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-5001
Practice Address - Country:US
Practice Address - Phone:189-636-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6976-15122300000X
390200000X
MND13771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program