Provider Demographics
NPI:1841209574
Name:KLUTH, EDWIN VICTOR (DDS MS)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:VICTOR
Last Name:KLUTH
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 12TH STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3269
Mailing Address - Country:US
Mailing Address - Phone:304-233-4246
Mailing Address - Fax:
Practice Address - Street 1:21 12TH STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3269
Practice Address - Country:US
Practice Address - Phone:304-233-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV20861223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0138765000Medicaid