Provider Demographics
NPI:1134817554
Name:HOARD, KELLEY NICOLE (DMD)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:NICOLE
Last Name:HOARD
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 1:4709B TRENT RIVER DR
Mailing Address - Street 2:
Mailing Address - City:TRENT WOODS
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7527
Mailing Address - Country:US
Mailing Address - Phone:252-474-9070
Mailing Address - Fax:
Practice Address - Street 1:935 MAKAHIKI WAY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2896
Practice Address - Country:US
Practice Address - Phone:808-537-8366
Practice Address - Fax:808-664-8736
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program