Provider Demographics
NPI:1720482003
Name:ZALESKI, KAYLIE BROOKE MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KAYLIE
Middle Name:BROOKE MARIE
Last Name:ZALESKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:KAYLIE
Other - Middle Name:BROOKE MARIE
Other - Last Name:ZALESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:181 EMMETT ST W
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-2963
Mailing Address - Country:US
Mailing Address - Phone:269-965-8866
Mailing Address - Fax:
Practice Address - Street 1:181 EMMETT ST W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-2963
Practice Address - Country:US
Practice Address - Phone:269-965-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902017203124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist