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General NPI Number Information
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NPI Number | 1689738593
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Entity Type | Individual
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Provider Name | CHARLES DAVID KLASS DDS
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4534 PRECISSI LN SUITE B
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City | STOCKTON
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State | CA
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Zip | 95207-6213
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Country | US
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Telephone | 209-478-4151
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Fax | 209-477-8981
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Provider Business Mailing Address
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Address Line | 4534 PRECISSI LN SUITE B
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City | STOCKTON
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State | CA
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Zip | 95207-6213
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Country | US
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Telephone | 209-478-4151
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Fax | 209-477-8981
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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 | 25160
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License Number State | CA
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