Provider Demographics
NPI:1972651420
Name:KLEBE, MORTON (DDS)
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:
Last Name:KLEBE
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 1:13624 HAWTHORNE BLVD
Mailing Address - Street 2:#101
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5818
Mailing Address - Country:US
Mailing Address - Phone:310-675-5665
Mailing Address - Fax:
Practice Address - Street 1:13624 HAWTHORNE BLVD
Practice Address - Street 2:#101
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5818
Practice Address - Country:US
Practice Address - Phone:310-675-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist