Provider Demographics
NPI:1396009148
Name:TEMPLE, KAYLEIGH EAVES (DDS)
Entity type:Individual
Prefix:DR
First Name:KAYLEIGH
Middle Name:EAVES
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KAYLEIGH
Other - Middle Name:AMANDA
Other - Last Name:EAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3805 BROOKSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-581-2900
Mailing Address - Fax:903-509-0160
Practice Address - Street 1:3805 BROOKSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-581-2900
Practice Address - Fax:903-509-0160
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307011223P0300X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics