MEDICARE: KEVIN DAVID KILEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10932	FL

General Provider Information

NPI Number	:	1912027848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN DAVID KILEY DDS

Provider Business Mailing Address
First Line	:	3820 TAMPA RD
Second Line	:	STE 201
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3609
Country	:	US
Telephone Number	:	727-787-7800
Fax Number	:	727-781-4175

Provider Business Practice Location Address
First Line	:	3820 TAMPA RD
Second Line	:	STE 201
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3609
Country	:	US
Telephone Number	:	727-787-7800
Fax Number	:	727-781-4175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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