Provider Demographics
NPI:1740359710
Name:KLECKER, JANIS KRISTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JANIS
Middle Name:KRISTIN
Last Name:KLECKER
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 1:11601 MINNETONKA MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5161
Mailing Address - Country:US
Mailing Address - Phone:952-938-8858
Mailing Address - Fax:
Practice Address - Street 1:11601 MINNETONKA MILLS RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5161
Practice Address - Country:US
Practice Address - Phone:952-938-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist