MEDICARE: DR. THEODORE 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	31083	CA

General Provider Information

NPI Number	:	1225151426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE W KLEIN DDS

Provider Business Mailing Address
First Line	:	7229 S LAND PARK DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3611
Country	:	US
Telephone Number	:	916-395-4010
Fax Number	:	916-395-2753

Provider Business Practice Location Address
First Line	:	7229 S LAND PARK DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3611
Country	:	US
Telephone Number	:	916-395-4010
Fax Number	:	916-395-2753

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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