Provider Demographics
NPI:1922159300
Name:KLICKA, JONATHAN JERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JERRY
Last Name:KLICKA
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 1:324 E WISCONSIN AVE STE 1429
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4327
Mailing Address - Country:US
Mailing Address - Phone:414-276-3454
Mailing Address - Fax:
Practice Address - Street 1:324 E WISCONSIN AVE STE 1429
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4327
Practice Address - Country:US
Practice Address - Phone:414-276-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00029531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice