Provider Demographics
NPI:1326308990
Name:KILTY, RENEE CATHERINE DAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:CATHERINE DAVIS
Last Name:KILTY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 BEN ALI DRIVE STE A
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2547
Mailing Address - Country:US
Mailing Address - Phone:859-236-6900
Mailing Address - Fax:
Practice Address - Street 1:1080 BEN ALI DRIVE STE A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2547
Practice Address - Country:US
Practice Address - Phone:859-236-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9049122300000X, 1223P0221X
KY9531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist