Provider Demographics
NPI:1225871866
Name:ALLRED, KILEE ROSE (RDH)
Entity type:Individual
Prefix:
First Name:KILEE
Middle Name:ROSE
Last Name:ALLRED
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 N 1350 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1955
Mailing Address - Country:US
Mailing Address - Phone:385-294-7615
Mailing Address - Fax:
Practice Address - Street 1:3237 N 1350 E
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-1955
Practice Address - Country:US
Practice Address - Phone:385-294-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11627380-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist