Provider Demographics
NPI:1386811487
Name:KLEIN, JEFFREY MAURICE (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MAURICE
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 THIERMAN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5010
Mailing Address - Country:US
Mailing Address - Phone:505-896-2822
Mailing Address - Fax:502-896-0442
Practice Address - Street 1:156 THIERMAN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5010
Practice Address - Country:US
Practice Address - Phone:502-896-2822
Practice Address - Fax:502-896-0442
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61900437Medicaid
KY60058807Medicaid