Provider Demographics
NPI:1881823789
Name:BLACK, KLINE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:KLINE
Middle Name:C
Last Name:BLACK
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 1:1500 E DESERT INN RD
Mailing Address - Street 2:STE #3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2550
Mailing Address - Country:US
Mailing Address - Phone:702-642-8101
Mailing Address - Fax:702-642-1131
Practice Address - Street 1:1500 E DESERT INN RD
Practice Address - Street 2:STE #3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2550
Practice Address - Country:US
Practice Address - Phone:702-642-8101
Practice Address - Fax:702-642-1131
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV58521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice