Healthcare Provider Details

I. General information

NPI: 1396307187
Provider Name (Legal Business Name): ALBERT E. KLITZKE DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
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

8790 CUYAMACA ST STE E
SANTEE CA
92071-4295
US

V. Phone/Fax

Practice location:
  • Phone: 619-596-0144
  • Fax: 619-596-9308
Mailing address:
  • Phone: 619-596-0144
  • Fax: 619-596-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT E KLITZKE IV
Title or Position: PRESIDENT
Credential: DDS
Phone: 619-596-0144