Provider Demographics
NPI:1396360293
Name:EYSIE, KESLEIGH JAYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KESLEIGH
Middle Name:JAYNE
Last Name:EYSIE
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 1:79 HAYDEN ROWE ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1847
Mailing Address - Country:US
Mailing Address - Phone:508-435-5437
Mailing Address - Fax:252-331-7222
Practice Address - Street 1:79 HAYDEN ROWE ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1847
Practice Address - Country:US
Practice Address - Phone:508-435-5437
Practice Address - Fax:252-331-7222
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN1858931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program