Healthcare Provider Details

I. General information

NPI: 1396360293
Provider Name (Legal Business Name): KESLEIGH JAYNE EYSIE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 HAYDEN ROWE ST
HOPKINTON MA
01748-1847
US

IV. Provider business mailing address

79 HAYDEN ROWE ST
HOPKINTON MA
01748-1847
US

V. Phone/Fax

Practice location:
  • Phone: 508-435-5437
  • Fax: 252-331-7222
Mailing address:
  • Phone: 508-435-5437
  • Fax: 252-331-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858931
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: