Provider Demographics
NPI:1770143380
Name:VANLAECKEN, KAYLEE ANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:KAYLEE
Middle Name:ANNA
Last Name:VANLAECKEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:ANNA
Other - Last Name:BAHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1513 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-7901
Mailing Address - Country:US
Mailing Address - Phone:605-216-2812
Mailing Address - Fax:
Practice Address - Street 1:4015 STEELE AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-225-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist