Provider Demographics
NPI:1669034104
Name:MORT, KAYLEIGH (DMD)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:MORT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:
Other - Last Name:FRECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8003 HINSDALE LN
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-3576
Mailing Address - Country:US
Mailing Address - Phone:412-527-0036
Mailing Address - Fax:
Practice Address - Street 1:1302 FREEDOM RD
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-5016
Practice Address - Country:US
Practice Address - Phone:724-772-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042322122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist