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General NPI Number Information
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NPI Number | 1104914241
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Entity Type | Individual
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Provider Name | ROBERT WAYNE KLOMPARENS DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 810 W WACKERLY ST SUITE A
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City | MIDLAND
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State | MI
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Zip | 48640-4716
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Country | US
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Telephone | 989-631-9860
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Fax | 989-631-3996
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Provider Business Mailing Address
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Address Line | 810 W WACKERLY ST SUITE A
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City | MIDLAND
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State | MI
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Zip | 48640-4716
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Country | US
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Telephone | 989-631-9860
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Fax | 989-631-3996
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12095
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License Number State | MI
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