Provider Demographics
NPI:1396032041
Name:BOSS, KILEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KILEY
Middle Name:
Last Name:BOSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 E SKYLINE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4856
Mailing Address - Country:US
Mailing Address - Phone:801-475-6500
Mailing Address - Fax:
Practice Address - Street 1:1508 E SKYLINE DR STE 400
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4856
Practice Address - Country:US
Practice Address - Phone:801-475-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8020079-8903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist