Provider Demographics
NPI:1740773399
Name:REDHEAD, KALEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:KALEIGH
Middle Name:
Last Name:REDHEAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 MOSS SIDE LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3440
Mailing Address - Country:US
Mailing Address - Phone:225-270-7904
Mailing Address - Fax:
Practice Address - Street 1:14608 S HARRELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2926
Practice Address - Country:US
Practice Address - Phone:225-751-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice