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NPI Code Detail

MEDICARE: KONTOVEROS KLOBAS CLARK LLC

MEDICARE: KONTOVEROS KLOBAS CLARK LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1770178956
Entity Type Code : Organization
Provider Name (Legal Business Name) : KONTOVEROS KLOBAS CLARK LLC
Provider Business Mailing Address
First Line : 2500 CLARK AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1111
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 CLARK AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1111
Country : US
Telephone Number : 216-860-1195
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. GEORGE KONTOVEROS
Credential :
Telephone Number : 216-273-1413
Provider Enumeration Date : 03/09/2021
Last Update Date : 03/11/2021

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Directions to “KONTOVEROS KLOBAS CLARK LLC ” Practice Location

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