DR. JOHN DALE KLOUCEK (NPI# 1972598357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972598357 |
| Entity Type | Individual |
| Full Name | DR. JOHN DALE KLOUCEK |
| Credential | DMD |
| Practice Address |
4130 Sw 100th Ave Beaverton OR 97005 |
| Mailing Address |
Po Box 1757 Beaverton OR 97075-1757 |
| Practice Telephone | 5036260998 |
| Practice Fax Number | 5036260988 |
| Mailing Telephone | 5036260998 |
| Mailing Fax Number | 5036260988 |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D6358 | OR | Dental Providers |
| Street Address |
4130 SW 100TH AVE |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700486438 | Jane Jeeyoon Kim | Dentist | 14425 Sw Allen Blvd # 1, Beaverton, OR 97005-4402 | 2020-10-30 |
| 1124631650 | Sugandha Gupta | Dentist | 2561 Nw 167th Ave, Beaverton, OR 97006-7643 | 2020-08-25 |
| 1508484205 | Dental Professionals of Oregon, P.C. | Dentist | 12850 Sw Canyon Rd Ste A, Beaverton, OR 97005-2166 | 2020-07-09 |
| 1568021871 | Evan Whisenant | Dentist | 13730 Sw Weir Rd, Beaverton, OR 97008-8063 | 2019-06-10 |
| 1528562535 | Caring Smiles Dental, LLC | Dentist | 15000 Sw Barrows Rd Ste 204, Beaverton, OR 97007-8778 | 2018-03-23 |
| 1043724917 | Cedar Hills Modern Dentistry, PC | Dentist | 2905 Sw Cedar Hills Blvd Ste 120, Beaverton, OR 97005-1342 | 2017-11-29 |
| 1124543640 | Patrick Ching Hsiang Chuang | Dentist | 12450 Sw Pioneer Ln, Ste B, Beaverton, OR 97008-8377 | 2017-08-04 |
| 1992242093 | Kaiser Foundation Health Plan of The Northwest | Dentist | 12450 Sw Walker Rd, Beaverton, OR 97005-1401 | 2017-01-26 |
| 1730633801 | Kedy Shen | Dentist | 15000 Sw Barrows Rd, Beaverton, OR 97007-8712 | 2016-08-06 |
| 1407217615 | Anita Trieu | Dentist | 12075 Sw Allen Blvd, Beaverton, OR 97005-4787 | 2016-03-15 |
| Find all providers in BEAVERTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.