=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114319035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES J. KLOER, DDS, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2015
-----------------------------------------------------
Last Update Date | 03/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 SE LOOP 338
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79762-9765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-580-5551
-----------------------------------------------------
Fax | 432-333-8899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 SE LOOP 338
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79762-9765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-580-5551
-----------------------------------------------------
Fax | 432-333-8899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DDS/PRACTICE OWNER
-----------------------------------------------------
Name | JAMES KLOER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-580-5551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------