MEDICARE: DR. HOWARD DALE KLEIN D.M.D.

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	04716	KY

General Provider Information

NPI Number	:	1619046646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD DALE KLEIN D.M.D.

Provider Business Mailing Address
First Line	:	1313 LYNDON LANE
Second Line	:	SUITE 214
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7302
Country	:	US
Telephone Number	:	502-425-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 LYNDON LANE
Second Line	:	SUITE 214
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7302
Country	:	US
Telephone Number	:	502-425-2442
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/09/2007

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