Provider Demographics
NPI:1881710754
Name:KLAMPERT, MARK M (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:KLAMPERT
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 1:1049 NORTH HARTLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001
Mailing Address - Country:US
Mailing Address - Phone:802-295-2458
Mailing Address - Fax:802-295-3985
Practice Address - Street 1:1049 NORTH HARTLAND ROAD
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001
Practice Address - Country:US
Practice Address - Phone:802-295-2458
Practice Address - Fax:802-295-3985
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT6251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice