Provider Demographics
NPI:1508908393
Name:KLEIN & COOK ORTHODONTICS LLC
Entity Type:Organization
Organization Name:KLEIN & COOK ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:618-244-7747
Mailing Address - Street 1:4210 LINCOLNSHIRE
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864
Mailing Address - Country:US
Mailing Address - Phone:618-244-7747
Mailing Address - Fax:618-244-7551
Practice Address - Street 1:4210 LINCOLNSHIRE
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864
Practice Address - Country:US
Practice Address - Phone:618-244-7747
Practice Address - Fax:618-244-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty