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NPI Code Detail

MEDICARE: DR. DANIEL JAMES KLEMMEDSON D.D.S., M.D.

MEDICARE: DR. DANIEL JAMES KLEMMEDSON D.D.S., M.D.
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
1204E00000XOral & Maxillofacial Surgery (D.M.D.)16321AZ
21223S0112XOral and Maxillofacial Surgery (Dentist)2774AZ

General Provider Information

NPI Number : 1235134503
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL JAMES KLEMMEDSON D.D.S., M.D.
Provider Business Mailing Address
First Line : 3150 N SWAN RD
Second Line :
City : TUCSON
State : AZ
Zip : 85712-1227
Country : US
Telephone Number : 520-745-6531
Fax Number : 520-790-3817
Provider Business Practice Location Address
First Line : 3655 E GRANT RD
Second Line :
City : TUCSON
State : AZ
Zip : 85716-2933
Country : US
Telephone Number : 520-767-0390
Fax Number : 520-309-2593
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 04/19/2025

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