Provider Demographics
NPI:1700298320
Name:KLINGSPORN, GARRETT (DDS)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:KLINGSPORN
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 1:8300 N FM 620
Mailing Address - Street 2:BUILDING N, SUITE 800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4007
Mailing Address - Country:US
Mailing Address - Phone:512-906-0906
Mailing Address - Fax:
Practice Address - Street 1:8300 N FM 620 RD STE 800
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4007
Practice Address - Country:US
Practice Address - Phone:512-906-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice