MEDICARE: DR. NANCY ELLEN KLEIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019020096	IL

General Provider Information

NPI Number	:	1083617070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY ELLEN KLEIN DDS

Provider Business Mailing Address
First Line	:	1773 RIDGELEE RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4348
Country	:	US
Telephone Number	:	847-831-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 ORCHARD ST STE 1
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-3107
Country	:	US
Telephone Number	:	847-254-6244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/24/2019

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