Healthcare Provider Details

I. General information

NPI: 1346297231
Provider Name (Legal Business Name): GARY DAVID KLASSER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119
US

IV. Provider business mailing address

1100 FLORIDA AVE BOX 140
NEW ORLEANS LA
70119
US

V. Phone/Fax

Practice location:
  • Phone: 504-619-8721
  • Fax: 504-941-8001
Mailing address:
  • Phone: 504-941-8407
  • Fax: 504-941-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberP129
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number136000100
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: