Provider Demographics
NPI:1023133121
Name:KLAREICH, SCOTT H (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:H
Last Name:KLAREICH
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 1:8197 N UNIVERSITY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1743
Mailing Address - Country:US
Mailing Address - Phone:954-720-0006
Mailing Address - Fax:954-720-1502
Practice Address - Street 1:8197 N UNIVERSITY DR STE 1
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1743
Practice Address - Country:US
Practice Address - Phone:954-720-0006
Practice Address - Fax:954-720-1502
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 79161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice