Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 1697 | SC |
NPI | 1184670093 |
---|---|
Provider Name | Dr. Brent J Klinger |
First Address | Orangeburg, SC 29118 |
Second Address | Orangeburg, SC 29118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZZ1697 | (05) | SC |