Provider Demographics
NPI:1912106105
Name:KAHLEY, MICHAELA ANN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:ANN
Last Name:KAHLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:MICHAELA
Other - Middle Name:ANN
Other - Last Name:FENIMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 GOLFSIDE DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7793
Mailing Address - Country:US
Mailing Address - Phone:904-367-1722
Mailing Address - Fax:904-367-1739
Practice Address - Street 1:9000 GOLFSIDE DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7793
Practice Address - Country:US
Practice Address - Phone:904-731-4343
Practice Address - Fax:904-731-2783
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist