Provider Demographics
NPI:1497893697
Name:H. RAYMOND KLEIN, D.D.S., P.A.
Entity Type:Organization
Organization Name:H. RAYMOND KLEIN, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:H.
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-743-2000
Mailing Address - Street 1:943 CESERY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5635
Mailing Address - Country:US
Mailing Address - Phone:904-743-2000
Mailing Address - Fax:904-725-8569
Practice Address - Street 1:943 CESERY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5635
Practice Address - Country:US
Practice Address - Phone:904-743-2000
Practice Address - Fax:904-725-8569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN33511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071684700Medicaid
FL073459400Medicaid