Healthcare Provider Details

I. General information

NPI: 1558560979
Provider Name (Legal Business Name): NANCY F KLINE DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E MAIN ST
LEIPSIC OH
45856-1243
US

IV. Provider business mailing address

15 E MAIN ST
LEIPSIC OH
45856-1243
US

V. Phone/Fax

Practice location:
  • Phone: 419-943-2278
  • Fax:
Mailing address:
  • Phone: 419-943-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY F KLINE
Title or Position: DENTIST
Credential: DMD
Phone: 859-492-7262