Provider Demographics
NPI:1124034244
Name:KLEIN, KEVIN B (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:B
Last Name:KLEIN
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 1:70 E 91ST ST
Mailing Address - Street 2:103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1561
Mailing Address - Country:US
Mailing Address - Phone:317-844-6000
Mailing Address - Fax:317-844-7321
Practice Address - Street 1:70 EAST 91ST
Practice Address - Street 2:103
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1550
Practice Address - Country:US
Practice Address - Phone:317-844-6000
Practice Address - Fax:317-844-7321
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN81081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice