Provider Demographics
NPI:1750508727
Name:PHILIP J. KLUMP,DDS,LLC
Entity type:Organization
Organization Name:PHILIP J. KLUMP,DDS,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLUMP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-522-3633
Mailing Address - Street 1:6917 OLD SEWARD HWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2276
Mailing Address - Country:US
Mailing Address - Phone:907-522-3633
Mailing Address - Fax:907-344-1737
Practice Address - Street 1:6917 OLD SEWARD HWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2276
Practice Address - Country:US
Practice Address - Phone:907-522-3633
Practice Address - Fax:907-344-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA7471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDDG513Medicaid