Healthcare Provider Details

I. General information

NPI: 1962322065
Provider Name (Legal Business Name): JACK KLAR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 KAEN RD
OREGON CITY OR
97045-4090
US

IV. Provider business mailing address

4893 PARKVIEW DR APT J
LAKE OSWEGO OR
97035-2439
US

V. Phone/Fax

Practice location:
  • Phone: 503-722-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12391
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: