Provider Demographics
NPI:1245341320
Name:BRIAN S KLOHN DMD PA
Entity type:Organization
Organization Name:BRIAN S KLOHN DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-657-7400
Mailing Address - Street 1:19 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:08733
Mailing Address - Country:US
Mailing Address - Phone:732-657-7400
Mailing Address - Fax:732-657-2200
Practice Address - Street 1:19 UNION AVE
Practice Address - Street 2:
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733
Practice Address - Country:US
Practice Address - Phone:732-657-7400
Practice Address - Fax:732-657-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO17801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty