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General NPI Number Information
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NPI Number | 1427540368
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Entity Type | Individual
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Provider Name | MARY KIRKPATRICK KLUG DDS
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Gender | Female
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 1308 N KELLY AVE
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City | EDMOND
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State | OK
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Zip | 73003-3906
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Country | US
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Telephone | 405-216-5299
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Fax | 405-216-3358
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Provider Business Mailing Address
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Address Line | 3105 KIRBY WHITTEN RD
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City | BARTLETT
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State | TN
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Zip | 38134-2822
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 10775
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7653
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License Number State | OK
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