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General NPI Number Information
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NPI Number | 1447614318
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Entity Type | Individual
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Provider Name | CHRISTOPHER DAVID KLEKAMP D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 1351 113TH AVE NE STE 400B
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City | BLAINE
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State | MN
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Zip | 55434-3874
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Country | US
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Telephone | 763-415-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 1351 113TH AVE NE STE 400B
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City | BLAINE
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State | MN
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Zip | 55434-3874
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Country | US
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Telephone | 637-415-1222
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1002273-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D14048
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License Number State | MN
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