Provider Demographics
NPI:1427129790
Name:KAILES, BETH E (DMD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:E
Last Name:KAILES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2245 PLANTATION CENTER DR
Mailing Address - Street 2:SUITE 36
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-3352
Mailing Address - Country:US
Mailing Address - Phone:904-215-7800
Mailing Address - Fax:904-215-7887
Practice Address - Street 1:1998 RIVERGATE DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-8686
Practice Address - Country:US
Practice Address - Phone:904-541-1444
Practice Address - Fax:904-541-1444
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL167531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry