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NPI Code Detail

MEDICARE: DR. JASON KLEVANSKY DMD

MEDICARE: DR. JASON KLEVANSKY DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDS028119LPA
2122300000XDentistDN012805GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1157593OTHERPAUNITED CONCORDIA

General Provider Information

NPI Number : 1053315952
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON KLEVANSKY DMD
Provider Business Mailing Address
First Line : 3455 LAWRENCEVILLE HWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-4101
Country : US
Telephone Number : 770-921-1115
Fax Number :
Provider Business Practice Location Address
First Line : 3455 LAWRENCEVILLE HWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-4101
Country : US
Telephone Number : 770-921-1115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 07/21/2022

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