MEDICARE: DR. KENNETH W 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	22D100935600	NJ

General Provider Information

NPI Number	:	1184939126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH W KLEIN DDS

Provider Business Mailing Address
First Line	:	1995 E GLEN AVE
Second Line	:
City	:	TOWNSHIP OF WASHINGTON
State	:	NJ
Zip	:	07676-4510
Country	:	US
Telephone Number	:	201-444-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1995 E GLEN AVE
Second Line	:
City	:	TOWNSHIP OF WASHINGTON
State	:	NJ
Zip	:	07676-4510
Country	:	US
Telephone Number	:	201-444-8444
Fax Number	:

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

Provider Enumeration Date	:	08/14/2010
Last Update Date	:	08/14/2010

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