Provider Demographics
NPI:1124179890
Name:KLEIN, CHRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2706
Mailing Address - Country:US
Mailing Address - Phone:718-984-7162
Mailing Address - Fax:718-967-1247
Practice Address - Street 1:79 NELSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2706
Practice Address - Country:US
Practice Address - Phone:718-984-7162
Practice Address - Fax:718-967-1247
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0474761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice