Provider Demographics
NPI:1104484088
Name:KAILEY, RITIKA (DMD)
Entity type:Individual
Prefix:DR
First Name:RITIKA
Middle Name:
Last Name:KAILEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SHAWMUT AVE UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2297
Mailing Address - Country:US
Mailing Address - Phone:317-847-2575
Mailing Address - Fax:
Practice Address - Street 1:791 TURNER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6314
Practice Address - Country:US
Practice Address - Phone:207-558-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN47191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice