MEDICARE: ANTONI KLEDARAS DDS PA

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
1	122300000X	Dentist	G10000932	DE

General Provider Information

NPI Number	:	1295940302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTONI KLEDARAS DDS PA

Provider Business Mailing Address
First Line	:	249 PHILADELPHIA PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-3109
Country	:	US
Telephone Number	:	302-762-2185
Fax Number	:	302-762-2186

Provider Business Practice Location Address
First Line	:	249 PHILADELPHIA PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-3109
Country	:	US
Telephone Number	:	302-762-2185
Fax Number	:	302-762-2186

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTONI WILLIAM KLEDARAS
Credential	:	DDS
Telephone Number	:	302-762-2185

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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