Provider Demographics
NPI:1053209890
Name:KLINE, SAMUEL GALVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GALVIN
Last Name:KLINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 N 158TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2851
Mailing Address - Country:US
Mailing Address - Phone:402-514-7089
Mailing Address - Fax:
Practice Address - Street 1:1105 HOWARD ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2841
Practice Address - Country:US
Practice Address - Phone:402-505-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE81321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice