Healthcare Provider Details

I. General information

NPI: 1639489479
Provider Name (Legal Business Name): W. DOUGLAS KLEIN, DMD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 SWIFT BLVD SUITE A
RICHLAND WA
99352-3541
US

IV. Provider business mailing address

725 SWIFT BLVD SUITE A
RICHLAND WA
99352-3541
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-6686
  • Fax: 509-946-0462
Mailing address:
  • Phone: 509-943-6686
  • Fax: 509-946-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberD4952
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberDE00004943
License Number StateWA

VIII. Authorized Official

Name: DR. WALTER DOUGLAS KLEIN
Title or Position: OWNER, ORAL SURGEON
Credential: DMD
Phone: 509-943-6686