Healthcare Provider Details

I. General information

NPI: 1376550426
Provider Name (Legal Business Name): KLEMENT JUNGMAN & VARGA DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 59TH ST W
BRADENTON FL
34209
US

IV. Provider business mailing address

2103 59TH ST W
BRADENTON FL
34209
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2766
  • Fax: 941-795-7531
Mailing address:
  • Phone: 941-792-2766
  • Fax: 941-795-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN9109
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN11099
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN15328
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN6193
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT J KLEMENT
Title or Position: DOCTOR
Credential:
Phone: 941-792-2766