Healthcare Provider Details

I. General information

NPI: 1962078212
Provider Name (Legal Business Name): LAURA ANTONIA YUNATAN KLEIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA KLEIN DMD

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5413 WEAVER ST
CHATTANOOGA TN
37412-3335
US

IV. Provider business mailing address

5413 WEAVER ST
CHATTANOOGA TN
37412-3335
US

V. Phone/Fax

Practice location:
  • Phone: 770-778-8815
  • Fax:
Mailing address:
  • Phone: 770-778-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12312
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: