Provider Demographics
NPI:1215143813
Name:KLEINE, JARED CARTER (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:CARTER
Last Name:KLEINE
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:PO BOX 330
Mailing Address - Street 2:ROUTE 29 NORTH
Mailing Address - City:MADISON
Mailing Address - State:VA
Mailing Address - Zip Code:22727-0330
Mailing Address - Country:US
Mailing Address - Phone:540-948-4812
Mailing Address - Fax:540-948-4831
Practice Address - Street 1:1333 NORTH SEMINOLE TRAIL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-0330
Practice Address - Country:US
Practice Address - Phone:540-948-4812
Practice Address - Fax:540-948-4831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice