Healthcare Provider Details

I. General information

NPI: 1629059399
Provider Name (Legal Business Name): NORMAN J KLAYMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

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

III. Provider practice location address

308 NORTH MAIN ST
GAINESVILLE MO
65655
US

IV. Provider business mailing address

P O BOX 338
GAINESVILLE MO
65655-0338
US

V. Phone/Fax

Practice location:
  • Phone: 417-679-4629
  • Fax:
Mailing address:
  • Phone: 417-679-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number011701
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: