Healthcare Provider Details

I. General information

NPI: 1912673534
Provider Name (Legal Business Name): KATIE KLEIN ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CHESTNUT ST
NEEDHAM MA
02492-2504
US

IV. Provider business mailing address

32 CHESTNUT ST
NEEDHAM MA
02492-2504
US

V. Phone/Fax

Practice location:
  • Phone: 215-901-1119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KATHERINE P. KLEIN
Title or Position: MANAGER
Credential: DMD, MS
Phone: 781-444-0846