Provider Demographics
NPI:1396951737
Name:KLOCKO, KAREN H (DDS)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:H
Last Name:KLOCKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2547
Mailing Address - Country:US
Mailing Address - Phone:410-721-5363
Mailing Address - Fax:
Practice Address - Street 1:1375 DEFENSE HWY
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1903
Practice Address - Country:US
Practice Address - Phone:410-721-7020
Practice Address - Fax:301-858-0500
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD88981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice