Provider Demographics
NPI:1881210714
Name:PATEL, KAITLYN SKIDMORE (DMD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:SKIDMORE
Last Name:PATEL
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 1:62 TIMBERCREST EST
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-1708
Mailing Address - Country:US
Mailing Address - Phone:606-273-5427
Mailing Address - Fax:
Practice Address - Street 1:301 E CENTRAL ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2303
Practice Address - Country:US
Practice Address - Phone:606-573-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice