Healthcare Provider Details

I. General information

NPI: 1083042469
Provider Name (Legal Business Name): KLEIN ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 LINCOLNSHIRE DR
MOUNT VERNON IL
62864-2156
US

IV. Provider business mailing address

4210 LINCOLNSHIRE DR
MOUNT VERNON IL
62864-2156
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-7747
  • Fax:
Mailing address:
  • Phone: 618-244-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER K KLEIN
Title or Position: PARTNER
Credential: DMD, MS
Phone: 618-244-7747