Provider Demographics
NPI:1619026101
Name:KLEIN, MICHAEL DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
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 1:227 N EL CAMINO REAL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2807
Mailing Address - Country:US
Mailing Address - Phone:760-634-2082
Mailing Address - Fax:
Practice Address - Street 1:227 N EL CAMINO REAL
Practice Address - Street 2:SUITE 104
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2807
Practice Address - Country:US
Practice Address - Phone:760-634-2082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42345122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist