Provider Demographics
NPI:1740430875
Name:KLEIN, ERIC MITCHELL (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MITCHELL
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1854
Mailing Address - Country:US
Mailing Address - Phone:617-547-9100
Mailing Address - Fax:617-547-2962
Practice Address - Street 1:2400 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1854
Practice Address - Country:US
Practice Address - Phone:617-547-9100
Practice Address - Fax:617-547-2962
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143-611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1223G0001XOtherDE CARE