Provider Demographics
NPI:1205904984
Name:HERBERT A. KLONTZ D.D.S. INC
Entity type:Organization
Organization Name:HERBERT A. KLONTZ D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:ARVID
Authorized Official - Last Name:KLONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:405-848-4809
Mailing Address - Street 1:3621 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2041
Mailing Address - Country:US
Mailing Address - Phone:405-848-4809
Mailing Address - Fax:405-848-4869
Practice Address - Street 1:3621 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-2041
Practice Address - Country:US
Practice Address - Phone:405-848-4809
Practice Address - Fax:405-848-4869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty