Provider Demographics
NPI:1972784585
Name:KLUTH, JENNIFER KATHLEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KATHLEEN
Last Name:KLUTH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1238
Mailing Address - Country:US
Mailing Address - Phone:518-885-3877
Mailing Address - Fax:518-885-3229
Practice Address - Street 1:7 UNION ST
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1238
Practice Address - Country:US
Practice Address - Phone:518-885-3877
Practice Address - Fax:518-885-3229
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539061223G0001X
CT0099011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice