Individual
DR. RICHARD J KLOCKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
306 WEST LIBERTY ST, ROME, NY 13440-5744
(315) 336-6380
(315) 338-0861
Mailing address
306 WEST LIBERTY ST, ROME, NY 13440-5744
(315) 336-6380
(315) 338-0861
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
040151-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01180249
—
NY
Enumeration date
08/24/2006
Last updated
07/08/2007
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