Healthcare Provider Details

I. General information

NPI: 1700620010
Provider Name (Legal Business Name): KAILEY MARIE VREDENBURG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 GRAND LELY DR BLDG L
NAPLES FL
34113-1753
US

IV. Provider business mailing address

7505 GRAND LELY DR BLDG L
NAPLES FL
34113-1753
US

V. Phone/Fax

Practice location:
  • Phone: 239-920-4523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDRPM2755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: