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General NPI Number Information
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NPI Number | 1669034104
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Entity Type | Individual
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Provider Name | KAYLEIGH MORT DMD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 1302 FREEDOM RD
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-5016
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Country | US
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Telephone | 724-772-2788
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Fax |
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Provider Business Mailing Address
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Address Line | 8003 HINSDALE LN
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City | MC DONALD
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State | PA
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Zip | 15057-3576
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Country | US
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Telephone | 412-527-0036
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042322
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License Number State | PA
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