Jason Klevansky, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN012805 Issued in GA

Practice address

3455 Lawrenceville Hwy
Lawrenceville, GA 30044-4101

Phone

(770) 921-1115

NPI assigned

Jun 8, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gwinnett Family Dental Care

  • Dentist
  • Lawrenceville, GA
  • NPI 1316112360
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1053315952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 LAWRENCEVILLE HWY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300444101",
            "telephone_number": "770-921-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 LAWRENCEVILLE HWY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300444101",
            "telephone_number": "770-921-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEVANSKY",
        "first_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS028119L",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN012805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "157593",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Calysta Kitchens-Cole, LCSW
• Sarah Kiwanuka, APRN
• KL Medical Clinic, LLC.
• Rebeca C Klatt, NP-C
• Laurie Lynn Klebosky, PHARMD
• John Randall Kludt, M.D.
• Knight Wellness
• Krystal Knight, NP
• Rodney Knight
• Trevor T Knight, LPC

• Dentist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.