Basic Information
| Provider Information | |||||||||
| NPI: | 1306487160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 RICO DR N | ||||||||
| Address2: | |||||||||
| City: | MORGANVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077512019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325475297 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2110 MAPLE AVE APT BSMT | ||||||||
| Address2: | |||||||||
| City: | SOUTH PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070804795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189637272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2019 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 122300000X | 22DI02822400 | NJ | Y | Dental Providers | Dentist |
No ID Information.