Healthcare Provider Details

I. General information

NPI: 1205904984
Provider Name (Legal Business Name): HERBERT A. KLONTZ D.D.S. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 NW 63RD ST
OKLAHOMA CITY OK
73116-2041
US

IV. Provider business mailing address

3621 NW 63RD ST
OKLAHOMA CITY OK
73116-2041
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-4809
  • Fax: 405-848-4869
Mailing address:
  • Phone: 405-848-4809
  • Fax: 405-848-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2895
License Number StateOK

VIII. Authorized Official

Name: DR. HERBERT ARVID KLONTZ
Title or Position: PRESIDENT ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 405-848-4809