Healthcare Provider Details

I. General information

NPI: 1871048157
Provider Name (Legal Business Name): KYLE AUSTIN FIELDS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 07/03/2021
Certification Date: 07/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # D7-6
GAINESVILLE FL
32610-1098
US

IV. Provider business mailing address

1600 SW ARCHER RD # D7-6
GAINESVILLE FL
32610-0416
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6750
  • Fax: 352-392-7609
Mailing address:
  • Phone: 352-273-6750
  • Fax: 352-392-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 21973
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN21973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: