Healthcare Provider Details

I. General information

NPI: 1619046646
Provider Name (Legal Business Name): HOWARD DALE KLEIN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 LYNDON LANE SUITE 214
LOUISVILLE KY
40222-7302
US

IV. Provider business mailing address

1313 LYNDON LANE SUITE 214
LOUISVILLE KY
40222-7302
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-2442
  • Fax:
Mailing address:
  • Phone: 502-425-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number04716
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: