Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS030955L | PA |
NPI | 1003034984 |
---|---|
Provider Name | Mr. Kevin John Klatte |
First Address | Phila, PA 19149 |
Second Address | Philadelphia, PA 19149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |