Provider Demographics
NPI:1750171567
Name:SMITH, KALENE ELIZABETH (DH)
Entity type:Individual
Prefix:
First Name:KALENE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1348
Mailing Address - Country:US
Mailing Address - Phone:509-834-8299
Mailing Address - Fax:
Practice Address - Street 1:25965 TYTLER RD NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9102
Practice Address - Country:US
Practice Address - Phone:206-403-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60774824124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist