Provider Demographics
NPI:1447631106
Name:LEBENS, KYLEY M (DDS)
Entity type:Individual
Prefix:
First Name:KYLEY
Middle Name:M
Last Name:LEBENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 CHIPPEWA CIR
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1528
Mailing Address - Country:US
Mailing Address - Phone:651-399-7660
Mailing Address - Fax:
Practice Address - Street 1:828 HAWTHORNE AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3252
Practice Address - Country:US
Practice Address - Phone:651-774-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist