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General NPI Number Information
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NPI Number | 1639593965
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Entity Type | Organization
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Legal Business Name | KLEIN DENTAL GROUP LLC
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 12 WESTWOODS DR
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City | LIBERTY
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State | MO
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Zip | 64068
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Country | US
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Telephone | 816-781-0993
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Fax |
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Provider Business Mailing Address
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Address Line | 12 WESTWOODS DR
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City | LIBERTY
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State | MO
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Zip | 64068
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Country | US
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Telephone | 816-781-0993
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ROBERT K KLEIN
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Credential | D.D.S.
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Telephone | 816-781-0993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | LC1364579
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License Number State | MO
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