Individual
DR. BRIAN D KLOCKOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4488 N BRANCH ST, WABENO, WI 54566-0161
(715) 473-6711
Mailing address
PO BOX 161, WABENO, WI 54566-0161
(715) 473-6711
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2274
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33386800
—
WI
Enumeration date
08/11/2006
Last updated
07/08/2007
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