Healthcare Provider Details

I. General information

NPI: 1255582219
Provider Name (Legal Business Name): WILLIAM A. KLENK DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberWV 2864
License Number StateWV

VIII. Authorized Official

Name: WILLIAM ADAM KLENK
Title or Position: PRESIDENT
Credential: DDS
Phone: 304-658-5282