Provider Demographics
NPI:1184517468
Name:EDEN, KYLEE (DMD)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:EDEN
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 1:125 ROCKWOOD ESTS
Mailing Address - Street 2:
Mailing Address - City:WEST GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-3024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:327 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-4021
Practice Address - Country:US
Practice Address - Phone:207-474-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN52581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice