Healthcare Provider Details

I. General information

NPI: 1083606651
Provider Name (Legal Business Name): ALBERT ERNST KLITZKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 CUYAMACA ST STE E
SANTEE CA
92071-4295
US

IV. Provider business mailing address

11717 CALLE TRUCKSESS
EL CAJON CA
92019-4819
US

V. Phone/Fax

Practice location:
  • Phone: 619-596-0144
  • Fax:
Mailing address:
  • Phone: 619-670-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number33433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: