Provider Demographics
NPI:1629281019
Name:KIEFER, AUDRA ROSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:ROSE
Last Name:KIEFER
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 1:203 S ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9212
Mailing Address - Country:US
Mailing Address - Phone:610-841-4711
Mailing Address - Fax:
Practice Address - Street 1:203 S ROUTE 100
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9212
Practice Address - Country:US
Practice Address - Phone:610-841-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0355491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics