Healthcare Provider Details

I. General information

NPI: 1831180355
Provider Name (Legal Business Name): KAREN NADINE CLISTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E NAPIER AVE
BENTON HARBOR MI
49022-3900
US

IV. Provider business mailing address

1220 E NAPIER AVE
BENTON HARBOR MI
49022-3900
US

V. Phone/Fax

Practice location:
  • Phone: 269-925-2113
  • Fax: 269-925-2191
Mailing address:
  • Phone: 269-925-2113
  • Fax: 269-925-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14250
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: