Provider Demographics
NPI:1699905455
Name:HAINDS, KILEY (DMD)
Entity type:Individual
Prefix:DR
First Name:KILEY
Middle Name:
Last Name:HAINDS
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 1:22 JACOBS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1756
Mailing Address - Country:US
Mailing Address - Phone:217-370-7681
Mailing Address - Fax:
Practice Address - Street 1:1900 SILVER GLEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3316
Practice Address - Country:US
Practice Address - Phone:847-888-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0276711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice