Healthcare Provider Details

I. General information

NPI: 1396853313
Provider Name (Legal Business Name): SCOTT B. KLIMAJ, DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GARNETT LN SUITE 8
GREENVILLE RI
02828-1414
US

IV. Provider business mailing address

1 GARNETT LN SUITE 8
GREENVILLE RI
02828-1414
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-3200
  • Fax: 401-949-5213
Mailing address:
  • Phone: 401-949-3200
  • Fax: 401-949-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2653
License Number StateRI

VIII. Authorized Official

Name: DR. SCOTT KLIMAJ
Title or Position: OWNER
Credential: DMD
Phone: 401-949-3200