Provider Demographics
NPI:1558927228
Name:KLEINBAUM, ERICA (DMD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KLEINBAUM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DALEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2592
Mailing Address - Country:US
Mailing Address - Phone:914-671-3141
Mailing Address - Fax:
Practice Address - Street 1:167 GANO ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3808
Practice Address - Country:US
Practice Address - Phone:401-274-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics