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General NPI Number Information
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NPI Number | 1114507779
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Entity Type | Individual
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Provider Name | KAYLA LYNN MOLLER DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 2127 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60622-5295
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Country | US
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Telephone | 773-904-0095
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Fax |
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Provider Business Mailing Address
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Address Line | 1164 W MADISON ST UNIT 326
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City | CHICAGO
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State | IL
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Zip | 60607-3867
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019033662
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License Number State | IL
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