Provider Demographics
NPI:1942422027
Name:KLEIN, EMMANUEL CHRISTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:CHRISTIAN
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E MCDOWELL RD STE LL3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2618
Mailing Address - Country:US
Mailing Address - Phone:602-256-0605
Mailing Address - Fax:
Practice Address - Street 1:1010 E MCDOWELL RD STE LL3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-256-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479231223G0001X, 1223P0700X
AZ66151223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47923OtherSTATE LICENSE