Provider Demographics
NPI:1710505227
Name:SUBLETTE, KANDICE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KANDICE
Middle Name:
Last Name:SUBLETTE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 SUTTER WOODS RD
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-2581
Mailing Address - Country:US
Mailing Address - Phone:636-359-9802
Mailing Address - Fax:
Practice Address - Street 1:1314 SUTTER WOODS RD
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-2581
Practice Address - Country:US
Practice Address - Phone:636-359-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist