Provider Demographics
NPI:1225196033
Name:KLEIN, GERALD C (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:C
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 S DATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5840
Mailing Address - Country:US
Mailing Address - Phone:503-504-2758
Mailing Address - Fax:
Practice Address - Street 1:3815 S DATE ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5840
Practice Address - Country:US
Practice Address - Phone:503-504-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD42431223G0001X
WADE000105001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082706OtherOMAP