Provider Demographics
NPI:1124126206
Name:KAIS, CONNIE I (DDS)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:I
Last Name:KAIS
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 1:3151 S WHITE RD
Mailing Address - Street 2:#101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4045
Mailing Address - Country:US
Mailing Address - Phone:408-270-2273
Mailing Address - Fax:408-270-2336
Practice Address - Street 1:3151 S WHITE RD
Practice Address - Street 2:#101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4045
Practice Address - Country:US
Practice Address - Phone:408-270-2273
Practice Address - Fax:408-270-2336
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice