MEDICARE: DR. KYLE KEITH HARMON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7697803-9922	UT

General Provider Information

NPI Number	:	1205131380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE KEITH HARMON DDS

Provider Business Mailing Address
First Line	:	360 S FORT LN
Second Line	:	SUITE B-100
City	:	LAYTON
State	:	UT
Zip	:	84041-4259
Country	:	US
Telephone Number	:	801-544-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 S FORT LN
Second Line	:	SUITE B-100
City	:	LAYTON
State	:	UT
Zip	:	84041-4259
Country	:	US
Telephone Number	:	801-544-9777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	01/20/2011

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