Provider Demographics
NPI:1780368498
Name:CARROTHERS, KAYLA LYNN (DDS)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:CARROTHERS
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 1:321 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-1455
Mailing Address - Country:US
Mailing Address - Phone:641-394-3016
Mailing Address - Fax:
Practice Address - Street 1:321 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-1455
Practice Address - Country:US
Practice Address - Phone:641-394-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist