MEDICARE: KEVIN B KLEIN D.D.S.

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	8108	IN

General Provider Information

NPI Number	:	1124034244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN B KLEIN D.D.S.

Provider Business Mailing Address
First Line	:	70 E 91ST ST
Second Line	:	103
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1561
Country	:	US
Telephone Number	:	317-844-6000
Fax Number	:	317-844-7321

Provider Business Practice Location Address
First Line	:	70 EAST 91ST
Second Line	:	103
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1550
Country	:	US
Telephone Number	:	317-844-6000
Fax Number	:	317-844-7321

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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