Provider Demographics
NPI:1619046646
Name:KLEIN, HOWARD DALE (DMD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:DALE
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1313 LYNDON LANE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7302
Mailing Address - Country:US
Mailing Address - Phone:502-425-2442
Mailing Address - Fax:
Practice Address - Street 1:1313 LYNDON LANE
Practice Address - Street 2:SUITE 214
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-7302
Practice Address - Country:US
Practice Address - Phone:502-425-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY047161223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYT54091Medicare UPIN