MEDICARE: JONATHAN J KLINEMAN DDS INC. FAMILY DENTISTRY

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

General Provider Information

NPI Number	:	1386764058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN J KLINEMAN DDS INC. FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	27127 CHARDON RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1115
Country	:	US
Telephone Number	:	440-943-1117
Fax Number	:	440-943-9513

Provider Business Practice Location Address
First Line	:	27127 CHARDON RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1115
Country	:	US
Telephone Number	:	440-943-1117
Fax Number	:	440-943-9513

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JONATHAN J KLINEMAN
Credential	:
Telephone Number	:	440-943-1117

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/10/2008

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