Healthcare Provider Details

I. General information

NPI: 1083812150
Provider Name (Legal Business Name): STANLEY H KLEIN DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 KEN OAK RD.
BALTIMORE MD
21209
US

IV. Provider business mailing address

2215 KEN OAK RD.
BALTIMORE MD
21209
US

V. Phone/Fax

Practice location:
  • Phone: 443-271-3682
  • Fax: 410-466-6919
Mailing address:
  • Phone: 443-271-3682
  • Fax: 410-466-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4175
License Number StateMA

VIII. Authorized Official

Name: DR. STANLEY HOWARD KLEIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 410-435-2350