Healthcare Provider Details

I. General information

NPI: 1346098506
Provider Name (Legal Business Name): KAITLYN ALEXIS SAVAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9818 PARAMOUNT BLVD STE A
DOWNEY CA
90240-3865
US

IV. Provider business mailing address

1405 MAGNOLIA AVE
REDLANDS CA
92373-4921
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-6453
  • Fax:
Mailing address:
  • Phone: 909-362-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number110814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: