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NPI Code Detail

MEDICARE: DR. KYLE RATLIFF DDS

MEDICARE: DR. KYLE RATLIFF 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
11223G0001XGeneral Practice Dentistry12012769AIN
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1407219140
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYLE RATLIFF DDS
Provider Business Mailing Address
First Line : 308 PENINSULA DRIVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46814
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5058 E. STILL CIRCLE
Second Line :
City : MESA
State : AZ
Zip : 85206
Country : US
Telephone Number : 480-219-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2016
Last Update Date : 07/31/2017

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