Provider Demographics
NPI:1447663497
Name:KLAUS, MAX KEITH (DMD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:KEITH
Last Name:KLAUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 FLOWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9358
Mailing Address - Country:US
Mailing Address - Phone:601-939-4100
Mailing Address - Fax:
Practice Address - Street 1:2695 FLOWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9358
Practice Address - Country:US
Practice Address - Phone:601-939-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS374614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist