Provider Demographics
NPI:1780751586
Name:KLEFFNER, EDWARD CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CHARLES
Last Name:KLEFFNER
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 1:7935 216TH SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-774-9298
Mailing Address - Fax:425-778-5284
Practice Address - Street 1:7935 216TH SW
Practice Address - Street 2:SUITE C
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-774-9298
Practice Address - Fax:425-778-5284
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist