Provider Demographics
NPI:1265443675
Name:KLEIN, MYRON ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:ROY
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 1:228 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-456-5200
Mailing Address - Fax:718-418-4938
Practice Address - Street 1:228 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-456-5200
Practice Address - Fax:718-418-4938
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00290377Medicaid
AK5910066OtherDEA