MEDICARE: DR. DOUGLAS KLEIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DI17132	NJ

General Provider Information

NPI Number	:	1356492821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS KLEIN DDS

Provider Business Mailing Address
First Line	:	2110 MAPLE AVE
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-4744
Country	:	US
Telephone Number	:	908-757-6677
Fax Number	:	908-753-0584

Provider Business Practice Location Address
First Line	:	2110 MAPLE AVE
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-4744
Country	:	US
Telephone Number	:	908-757-6677
Fax Number	:	908-753-0584

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2007
Last Update Date	:	07/08/2007

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