1487100160 NPI number — GARY P. KLUGMAN, DDS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487100160 NPI number — GARY P. KLUGMAN, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARY P. KLUGMAN, DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BLANCO CIRCLE DENTAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487100160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
935 BLANCO CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93901-4446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-422-7838
Provider Business Mailing Address Fax Number:
831-422-1007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 BLANCO CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93901-4446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-422-7838
Provider Business Practice Location Address Fax Number:
831-422-1007
Provider Enumeration Date:
08/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KLUGMAN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
PHILLIP
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
831-422-7838

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  26192 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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