Individual provider Active NPI

Robert Holt Klein, D.D.S.PS

  • General Practice Dentistry
  • Lynden, WA
National Provider Identifier
1396814026
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4632 Issued in WA
Practice address
506 Grover St
#108
Lynden, WA 98264-1960
Phone
(360) 354-6036
Fax
(360) 354-5586
NPI assigned
Nov 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4632 WA Primary

Addresses

Primary practice location

506 Grover St
#108
Lynden, WA 98264-1960

Mailing address

506 Grover St
#108
Lynden, WA 98264-1960
Phone (360) 354-6036

Other identifiers 1

IdentifierTypeStateIssuer
5387105MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4632WAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1396814026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 GROVER ST",
            "address_2": "#108",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641960",
            "telephone_number": "360-354-6036",
            "fax_number": "360-354-5586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 GROVER ST",
            "address_2": "#108",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641960",
            "telephone_number": "360-354-6036",
            "fax_number": "360-354-5586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEIN",
        "first_name": "ROBERT",
        "middle_name": "HOLT",
        "name_prefix": "Mr.",
        "credential": "D.D.S.PS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "4632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5387105",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynden, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.