Provider Demographics
NPI:1780757021
Name:KLEINAITIS, VICTOR J (DDS)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:KLEINAITIS
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 1:8312 HICKORY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-6214
Mailing Address - Country:US
Mailing Address - Phone:901-753-8887
Mailing Address - Fax:
Practice Address - Street 1:473 HIGH POINT TER
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4621
Practice Address - Country:US
Practice Address - Phone:901-452-3197
Practice Address - Fax:901-452-3197
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS39871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice