MEDICARE: SMILE BY KYLE

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	332BC3200X	Customized Equipment (DME)
2	122300000X	Dentist

General Provider Information

NPI Number	:	1437011616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE BY KYLE

Provider Business Mailing Address
First Line	:	508 LAKEHURST RD STE 3B
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-8000
Country	:	US
Telephone Number	:	732-736-9100
Fax Number	:	732-736-9155

Provider Business Practice Location Address
First Line	:	508 LAKEHURST RD STE 3B
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-8000
Country	:	US
Telephone Number	:	732-736-9100
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	KENNETH DITMARS
Credential	:
Telephone Number	:	732-736-9100

Provider Enumeration Date	:	11/26/2025
Last Update Date	:	01/20/2026

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Directions to “SMILE BY KYLE ” Practice Location

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