Provider Demographics
NPI:1013646165
Name:NGUYEN, KAYLIE MY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KAYLIE
Middle Name:MY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:MY
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 CRABAPPLE CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3945
Mailing Address - Country:US
Mailing Address - Phone:301-503-7086
Mailing Address - Fax:
Practice Address - Street 1:3105 LIMESTONE RD STE 203
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2151
Practice Address - Country:US
Practice Address - Phone:302-995-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174821223P0300X
DEG1-00116091223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodontics