Provider Demographics
NPI:1043353964
Name:KLEIN, DONNA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:S
Last Name:KLEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 BYPASS RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2387
Mailing Address - Country:US
Mailing Address - Phone:859-737-1000
Mailing Address - Fax:859-737-1007
Practice Address - Street 1:2560 BYPASS RD
Practice Address - Street 2:SUITE #2
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2387
Practice Address - Country:US
Practice Address - Phone:859-737-1000
Practice Address - Fax:859-737-1007
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY77791223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60001575Medicaid
KY00000779OtherDELTA DENTAL