Provider Demographics
NPI:1962628644
Name:KLEIN, JARY T (JARY T KLEIN, DDS)
Entity Type:Individual
Prefix:DR
First Name:JARY
Middle Name:T
Last Name:KLEIN
Suffix:
Gender:M
Credentials:JARY T KLEIN, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12147 NATURAL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2018
Mailing Address - Country:US
Mailing Address - Phone:314-739-3700
Mailing Address - Fax:314-739-5048
Practice Address - Street 1:12147 NATURAL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2018
Practice Address - Country:US
Practice Address - Phone:314-739-3700
Practice Address - Fax:314-739-5048
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO013326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist