Healthcare Provider Details

I. General information

NPI: 1720151467
Provider Name (Legal Business Name): JOHN PAUL KLOOSTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 POST DR NE STE E
BELMONT MI
49306-8717
US

IV. Provider business mailing address

1259 POST DR NE STE E
BELMONT MI
49306-8717
US

V. Phone/Fax

Practice location:
  • Phone: 616-284-3200
  • Fax:
Mailing address:
  • Phone: 616-284-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017901
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: