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General NPI Number Information
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NPI Number | 1508359761
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Entity Type | Individual
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Provider Name | ERIK KLINTMALM DMD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 2403 LACY LN
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City | CARROLLTON
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State | TX
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Zip | 75006
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Country | US
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Telephone | 972-869-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 3808 MIRAMAR AVE
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City | DALLAS
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State | TX
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Zip | 75205-3126
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Country | US
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Telephone | 214-415-9996
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10882
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN.00203718
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 34105
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License Number State | TX
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