Healthcare Provider Details

I. General information

NPI: 1497963243
Provider Name (Legal Business Name): MICHAEL BARRY KLASS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N ARLINGTON HEIGHTS RD SUITE 165
BUFFALO GROVE IL
60089-8213
US

IV. Provider business mailing address

135 N ARLINGTON HEIGHTS RD SUITE 165
BUFFALO GROVE IL
60089-8213
US

V. Phone/Fax

Practice location:
  • Phone: 847-459-1875
  • Fax: 847-383-4701
Mailing address:
  • Phone: 847-459-1875
  • Fax: 847-383-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: