Provider Demographics
NPI:1508980764
Name:KLEIN, RICHARD ERIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ERIC
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 1:2017 JEFFERSON ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2419
Mailing Address - Country:US
Mailing Address - Phone:540-521-9721
Mailing Address - Fax:
Practice Address - Street 1:2017 SOUTH JEFFERSON ST
Practice Address - Street 2:CARILION DENTAL CARE
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-521-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413142122300000X
NC8666122300000X
FLDN171371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice