MEDICARE: CHAD L. KLEVEN DDS PS

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	1223G0001X	General Practice Dentistry	5977	WA

General Provider Information

NPI Number	:	1326205014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD L. KLEVEN DDS PS

Provider Business Mailing Address
First Line	:	870 11TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2402
Country	:	US
Telephone Number	:	360-425-4900
Fax Number	:	360-636-4641

Provider Business Practice Location Address
First Line	:	870 11TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2402
Country	:	US
Telephone Number	:	360-425-4900
Fax Number	:	360-636-4641

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. CHAD L KLEVEN
Credential	:	DDS
Telephone Number	:	360-425-4900

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	11/01/2016

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