MEDICARE: DR. KLINE C BLACK 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	1223G0001X	General Practice Dentistry	5852	NV

General Provider Information

NPI Number	:	1881823789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KLINE C BLACK D.M.D.

Provider Business Mailing Address
First Line	:	1500 E DESERT INN RD
Second Line	:	STE #3
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2550
Country	:	US
Telephone Number	:	702-642-8101
Fax Number	:	702-642-1131

Provider Business Practice Location Address
First Line	:	1500 E DESERT INN RD
Second Line	:	STE #3
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2550
Country	:	US
Telephone Number	:	702-642-8101
Fax Number	:	702-642-1131

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

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	12/27/2010

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