Healthcare Provider Details

I. General information

NPI: 1508971862
Provider Name (Legal Business Name): RUTH MONINA KLEVENS DDS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: R. MONINA KLEVENS

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

2481 MELINDA DR NE NE
ATLANTA GA
30345-1916
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone: 404-315-7104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN011493
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: