MEDICARE: TREVOR KLEIN DDS LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1093574865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREVOR KLEIN DDS LLC

Provider Business Mailing Address
First Line	:	1578 CONSTITUTION BLVD STE 1
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3544
Country	:	US
Telephone Number	:	803-366-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1578 CONSTITUTION BLVD STE 1
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3544
Country	:	US
Telephone Number	:	803-366-1456
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TREVOR KLEIN
Credential	:	DDS
Telephone Number	:	803-366-1456

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	03/15/2024

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