Healthcare Provider Details

I. General information

NPI: 1922604826
Provider Name (Legal Business Name): KILEY DENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MARCONI AVE STE 100
SACRAMENTO CA
95821-4856
US

IV. Provider business mailing address

2500 MARCONI AVE STE 100
SACRAMENTO CA
95821-4856
US

V. Phone/Fax

Practice location:
  • Phone: 916-485-4175
  • Fax: 916-993-9405
Mailing address:
  • Phone: 916-485-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: