Healthcare Provider Details

I. General information

NPI: 1063623031
Provider Name (Legal Business Name): ERIC KLEIN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MASSACHUSETTS AVE
CAMBRIDGE MA
02140
US

IV. Provider business mailing address

2400 MASSACHUSETTS AVENUE
CAMBRIDGE MA
02140
US

V. Phone/Fax

Practice location:
  • Phone: 617-547-9100
  • Fax: 617-547-2962
Mailing address:
  • Phone: 617-547-9100
  • Fax: 617-547-2962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberMA14361
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberMA14361
License Number StateMA

VIII. Authorized Official

Name: ELISHA FRANK
Title or Position: TREASURER BUS MGR
Credential:
Phone: 617-547-9100