Healthcare Provider Details

I. General information

NPI: 1104963206
Provider Name (Legal Business Name): EDWARD MARTIN KLINGER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 WESTMONT PLAZA
WESTMONT NJ
08108
US

IV. Provider business mailing address

7 HAMILTON CT
MOORESTOWN NJ
08057-3849
US

V. Phone/Fax

Practice location:
  • Phone: 856-869-8660
  • Fax: 856-869-8686
Mailing address:
  • Phone: 856-234-7083
  • Fax: 856-234-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDI016477
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS026054L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: