MEDICARE: DR. EDNA KLATT DEPAUL D.M.D.

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
1	1223G0001X	General Practice Dentistry	2529	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2529	OTHER	SC	SC DENTAL LICENCE
3	488297	OTHER	SC	UNITED CONCORDIA INS CO

General Provider Information

NPI Number	:	1861498180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDNA KLATT DEPAUL D.M.D.

Provider Business Mailing Address
First Line	:	701 LEADER LN
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-8152
Country	:	US
Telephone Number	:	843-345-2307
Fax Number	:	843-881-3161

Provider Business Practice Location Address
First Line	:	701 LEADER LN
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-8152
Country	:	US
Telephone Number	:	843-345-2307
Fax Number	:	843-881-3161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/08/2013

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