Provider Demographics
NPI:1336162791
Name:ERIC KLEIN, D.M.D. PC
Entity Type:Organization
Organization Name:ERIC KLEIN, D.M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-547-9100
Mailing Address - Street 1:2400 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1854
Mailing Address - Country:US
Mailing Address - Phone:617-547-9100
Mailing Address - Fax:617-547-2962
Practice Address - Street 1:2400 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1854
Practice Address - Country:US
Practice Address - Phone:617-547-9100
Practice Address - Fax:617-547-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty