Provider Demographics
NPI:1023457736
Name:KLEIN, MARK ALAN (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
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 1:115 N KANSAS AVE
Mailing Address - Street 2:POBOX 363
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654-2050
Mailing Address - Country:US
Mailing Address - Phone:785-877-3433
Mailing Address - Fax:
Practice Address - Street 1:115 N KANSAS AVE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654-2050
Practice Address - Country:US
Practice Address - Phone:785-877-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5478122300000X
NE4693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist