Provider Demographics
NPI:1720815863
Name:KES PLLC
Entity type:Organization
Organization Name:KES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTENIUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:405-509-8932
Mailing Address - Street 1:609 S. KELLY AVE.
Mailing Address - Street 2:STE. A-1
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003
Mailing Address - Country:US
Mailing Address - Phone:405-509-8932
Mailing Address - Fax:405-531-0808
Practice Address - Street 1:609 S. KELLY AVE.
Practice Address - Street 2:STE. A-1
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003
Practice Address - Country:US
Practice Address - Phone:405-509-8932
Practice Address - Fax:405-531-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty