Provider Demographics
NPI:1912027848
Name:KILEY, KEVIN DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVID
Last Name:KILEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 TAMPA RD
Mailing Address - Street 2:STE 201
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3609
Mailing Address - Country:US
Mailing Address - Phone:727-787-7800
Mailing Address - Fax:727-781-4175
Practice Address - Street 1:3820 TAMPA RD
Practice Address - Street 2:STE 201
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3609
Practice Address - Country:US
Practice Address - Phone:727-787-7800
Practice Address - Fax:727-781-4175
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL109321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice