=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386460152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUSTIN KLEINMAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2024
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 531 OLD WESTMINSTER PIKE STE 100-101
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-6273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-857-5700
-----------------------------------------------------
Fax | 410-876-0261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 531 OLD WESTMINSTER PIKE STE 100-101
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-6273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-857-5700
-----------------------------------------------------
Fax | 410-876-0261
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PERIODONTICS
-----------------------------------------------------
Name | JUSTIN KLEINMAN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 410-857-5700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------