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General NPI Number Information
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NPI Number | 1760850291
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Entity Type | Organization
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Legal Business Name | KLOBERDANZ ORAL SURGERY AND DENTAL IMPLANTS P.C.
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 2580 FOXFIELD RD STE 100
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City | ST CHARLES
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State | IL
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Zip | 60174-1411
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Country | US
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Telephone | 630-377-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 2580 FOXFIELD RD STE 100
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City | ST CHARLES
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State | IL
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Zip | 60174-1411
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Country | US
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Telephone | 630-377-7077
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN KLOBERDANZ
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Credential | D.D.S.
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Telephone | 630-377-7077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 021001535
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License Number State | IL
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