Healthcare Provider Details

I. General information

NPI: 1235205030
Provider Name (Legal Business Name): ADAM HINTZE KLEIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E MAIN ST
LUVERNE MN
56156-1830
US

IV. Provider business mailing address

115 E MAIN ST
LUVERNE MN
56156-1830
US

V. Phone/Fax

Practice location:
  • Phone: 507-283-9129
  • Fax: 507-283-4159
Mailing address:
  • Phone: 507-283-9129
  • Fax: 507-283-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12295
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: