Healthcare Provider Details

I. General information

NPI: 1366404717
Provider Name (Legal Business Name): CYNTHIA KLEINEGGER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SW CAMPUS DR SD-515
PORTLAND OR
97239-3001
US

IV. Provider business mailing address

PO BOX 10076
VAN NUYS CA
91410-0076
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8904
  • Fax:
Mailing address:
  • Phone: 805-578-8300
  • Fax: 805-578-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD8628
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: