=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396853313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTT B. KLIMAJ, DMD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 GARNETT LN SUITE 8
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02828-1414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-949-3200
-----------------------------------------------------
Fax | 401-949-5213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 GARNETT LN SUITE 8
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02828-1414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-949-3200
-----------------------------------------------------
Fax | 401-949-5213
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SCOTT KLIMAJ
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 401-949-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2653
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------