Provider Demographics
NPI:1396814026
Name:KLEIN, ROBERT HOLT (DDSPS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HOLT
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DDSPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 GROVER ST
Mailing Address - Street 2:#108
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1960
Mailing Address - Country:US
Mailing Address - Phone:360-354-6036
Mailing Address - Fax:360-354-5586
Practice Address - Street 1:506 GROVER ST
Practice Address - Street 2:#108
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1960
Practice Address - Country:US
Practice Address - Phone:360-354-6036
Practice Address - Fax:360-354-5586
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5387105Medicaid