Provider Demographics
NPI:1972079614
Name:LEIDHOLT, KYLEE (DMD)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:LEIDHOLT
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 1:719 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2709
Mailing Address - Country:US
Mailing Address - Phone:808-455-3485
Mailing Address - Fax:
Practice Address - Street 1:719 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2709
Practice Address - Country:US
Practice Address - Phone:808-455-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist