Provider Demographics
NPI:1639489479
Name:W. DOUGLAS KLEIN, DMD, PS
Entity Type:Organization
Organization Name:W. DOUGLAS KLEIN, DMD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-943-6686
Mailing Address - Street 1:725 SWIFT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3541
Mailing Address - Country:US
Mailing Address - Phone:509-943-6686
Mailing Address - Fax:509-946-0462
Practice Address - Street 1:725 SWIFT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3541
Practice Address - Country:US
Practice Address - Phone:509-943-6686
Practice Address - Fax:509-946-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004943261QS0112X
ORD4952261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000300821Medicare PIN