Provider Demographics
NPI:1487786844
Name:KLEIN, WALTER DOUGLAS (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:DOUGLAS
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 1:725 SWIFT BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-943-6686
Mailing Address - Fax:509-946-0462
Practice Address - Street 1:725 SWIFT BLVD
Practice Address - Street 2:STE A
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-943-6686
Practice Address - Fax:509-946-0462
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004943204E00000X
ORD4952204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000300821Medicare PIN