Provider Demographics
NPI:1992178529
Name:KLINE, LORENE ROSE
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:ROSE
Last Name:KLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORENE
Other - Middle Name:ROSE
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:29895 GREENFIELD RD
Mailing Address - Street 2:#101
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5867
Mailing Address - Country:US
Mailing Address - Phone:248-952-7737
Mailing Address - Fax:
Practice Address - Street 1:29895 GREENFIELD
Practice Address - Street 2:#101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:248-952-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902010620124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist