Provider Demographics
NPI:1639723208
Name:KLINE, JAMES JORDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JORDAN
Last Name:KLINE
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 1:386 DANTE CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-2406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PARRIS ISLAND
Practice Address - Street 2:DENTAL CLINIC
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:29905
Practice Address - Country:US
Practice Address - Phone:843-228-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice