Healthcare Provider Details

I. General information

NPI: 1316217540
Provider Name (Legal Business Name): ALEXIS LEE KLEINMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EXECUTIVE PARK DR ALBANY OMS GROUP
ALBANY NY
12203-3700
US

IV. Provider business mailing address

19075 NW TANASBOURNE DRIVE #300 SUNSET DENTAL OFFICE
HILLSBORO OR
97124-3700
US

V. Phone/Fax

Practice location:
  • Phone: 518-446-1001
  • Fax:
Mailing address:
  • Phone: 503-531-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD10023
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: