Provider Demographics
NPI:1659705085
Name:DAINIAK, KELLY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:DAINIAK
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 1:24600 S TAMIAMI TRL
Mailing Address - Street 2:STE 206
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7022
Mailing Address - Country:US
Mailing Address - Phone:239-949-8302
Mailing Address - Fax:239-949-8374
Practice Address - Street 1:24600 S TAMIAMI TRL
Practice Address - Street 2:STE 206
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7022
Practice Address - Country:US
Practice Address - Phone:239-949-8302
Practice Address - Fax:239-949-8374
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist