Provider Demographics
NPI:1205129012
Name:KLAVA, JEROD THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROD
Middle Name:THOMAS
Last Name:KLAVA
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 1:6545 FRANCE AVE SO.
Mailing Address - Street 2:SUITE 190
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-922-6949
Mailing Address - Fax:952-922-9287
Practice Address - Street 1:6545 FRANCE AVE. SO.
Practice Address - Street 2:SUITE 190
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-922-6949
Practice Address - Fax:952-922-9287
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND125251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics