Healthcare Provider Details

I. General information

NPI: 1548246945
Provider Name (Legal Business Name): WILLIAM ADAM KLENK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26496 MIDLAND TRAIL
HICO WV
25854-0497
US

IV. Provider business mailing address

PO BOX 497 26496 MIDLAND TRAIL
HICO WV
25854-0497
US

V. Phone/Fax

Practice location:
  • Phone: 304-658-5282
  • Fax: 304-658-5299
Mailing address:
  • Phone: 304-658-5282
  • Fax: 304-658-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2864
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: