Provider Demographics
NPI:1629739693
Name:GIOVARELLI, KAYLA MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MARIE
Last Name:GIOVARELLI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:MARIE
Other - Last Name:PELOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:760 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1851
Mailing Address - Country:US
Mailing Address - Phone:419-583-6745
Mailing Address - Fax:
Practice Address - Street 1:407 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-8662
Practice Address - Country:US
Practice Address - Phone:419-599-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31.014210124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist