Provider Demographics
NPI:1356711881
Name:PRESTON, KIANA RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:KIANA
Middle Name:RENEE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIANA
Other - Middle Name:
Other - Last Name:SLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2021 MONROE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2926
Mailing Address - Country:US
Mailing Address - Phone:313-565-5586
Mailing Address - Fax:
Practice Address - Street 1:2700 HAMLIN BLVD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2206
Practice Address - Country:US
Practice Address - Phone:313-561-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-27
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010217421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice