Provider Demographics
NPI:1295940302
Name:ANTONI KLEDARAS DDS PA
Entity type:Organization
Organization Name:ANTONI KLEDARAS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONI
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KLEDARAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-762-2185
Mailing Address - Street 1:249 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3109
Mailing Address - Country:US
Mailing Address - Phone:302-762-2185
Mailing Address - Fax:302-762-2186
Practice Address - Street 1:249 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-3109
Practice Address - Country:US
Practice Address - Phone:302-762-2185
Practice Address - Fax:302-762-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10000932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty