Provider Demographics
NPI:1023235603
Name:KLEIN, PETER BENNETT (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:BENNETT
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 1:1600 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6768
Mailing Address - Country:US
Mailing Address - Phone:954-782-1992
Mailing Address - Fax:954-782-0425
Practice Address - Street 1:1600 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6768
Practice Address - Country:US
Practice Address - Phone:954-782-1992
Practice Address - Fax:954-782-0425
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice