Provider Demographics
NPI:1013128438
Name:KLEVEN, CHAD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:L
Last Name:KLEVEN
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 1:870 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2402
Mailing Address - Country:US
Mailing Address - Phone:360-425-4900
Mailing Address - Fax:360-636-4641
Practice Address - Street 1:870 11TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2402
Practice Address - Country:US
Practice Address - Phone:360-425-4900
Practice Address - Fax:360-636-4641
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8719122300000X
WADE00008719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA201872862OtherTAX ID