Provider Demographics
NPI:1831504125
Name:HOUSLEY, KAILEY ANNE SMITH (DDS)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:ANNE SMITH
Last Name:HOUSLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAILEY
Other - Middle Name:ANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3015 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-1273
Mailing Address - Country:US
Mailing Address - Phone:208-419-3622
Mailing Address - Fax:208-419-3461
Practice Address - Street 1:3015 EAGLE DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-1273
Practice Address - Country:US
Practice Address - Phone:208-419-3622
Practice Address - Fax:208-419-3461
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0407771223P0221X
IDD-5011-PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry