Provider Demographics
NPI:1588911853
Name:KLEIN, TYLER (DDS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
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 1:5907 CARROLLTON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3020
Mailing Address - Country:US
Mailing Address - Phone:608-769-3736
Mailing Address - Fax:
Practice Address - Street 1:4724 SHARON RD STE L
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3337
Practice Address - Country:US
Practice Address - Phone:608-769-3736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC112101223G0001X
NV63001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice