Jon Klevansky, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

GA12590 Issued in GA

Practice address

3993 Lawrenceville Hwy
Suite 100a
Lilburn, GA 30047-2831

Phone

(770) 921-1115

Fax

(770) 564-3856

NPI assigned

Apr 4, 2007

Last updated

Jul 8, 2007By 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 1

Addresses

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

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528180411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3993 LAWRENCEVILLE HWY",
            "address_2": "SUITE 100A",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300472831",
            "telephone_number": "770-921-1115",
            "fax_number": "770-564-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3993 LAWRENCEVILLE HWY",
            "address_2": "SUITE 100A",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300472831",
            "telephone_number": "770-921-1115",
            "fax_number": "770-564-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEVANSKY",
        "first_name": "JON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "GA12590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Lilburn, GA
• Providers in Lilburn, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.