Provider Demographics
NPI:1962244319
Name:GOODE, KAITLYN LEANNE (DMD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LEANNE
Last Name:GOODE
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 1:366 PAINTED LEAF CT
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-6372
Mailing Address - Country:US
Mailing Address - Phone:502-655-2124
Mailing Address - Fax:
Practice Address - Street 1:1107 CROWN POINTE DR STE 210
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7281
Practice Address - Country:US
Practice Address - Phone:270-769-3858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist