Provider Demographics
NPI:1013944271
Name:KLEIN, GREGORY RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RICHARD
Last Name:KLEIN
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 1:128 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-1314
Mailing Address - Country:US
Mailing Address - Phone:973-209-6753
Mailing Address - Fax:845-986-0925
Practice Address - Street 1:66 GALLOWAY RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1719
Practice Address - Country:US
Practice Address - Phone:845-986-8846
Practice Address - Fax:845-986-0925
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048372-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice