Provider Demographics
NPI:1780603712
Name:KYES, JEFFREY M (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:KYES
Suffix:
Gender:M
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0026
Mailing Address - Country:US
Mailing Address - Phone:207-794-6577
Mailing Address - Fax:207-794-8383
Practice Address - Street 1:168 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4003
Practice Address - Country:US
Practice Address - Phone:207-794-6577
Practice Address - Fax:207-794-8383
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME21029311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice