Provider Demographics
NPI:1699510776
Name:KAMBRANIS, CAYLIE (DMD)
Entity type:Individual
Prefix:DR
First Name:CAYLIE
Middle Name:
Last Name:KAMBRANIS
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 1:30 ELMWOOD ST # 2A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3320
Mailing Address - Country:US
Mailing Address - Phone:438-872-2177
Mailing Address - Fax:
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5758
Practice Address - Country:US
Practice Address - Phone:207-623-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN5159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist