Provider Demographics
NPI:1235682147
Name:TODD, KAYLYNNE (RDH)
Entity Type:Individual
Prefix:MS
First Name:KAYLYNNE
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 WEBB LAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-2514
Mailing Address - Country:US
Mailing Address - Phone:541-604-5024
Mailing Address - Fax:541-278-7568
Practice Address - Street 1:73265 CONFEDERATED WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9099
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:541-278-7568
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6719124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist