Healthcare Provider Details

I. General information

NPI: 1144951096
Provider Name (Legal Business Name): KYLE MILLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 GRAND LELY DR
NAPLES FL
34113-1753
US

IV. Provider business mailing address

1600 SW ARCHER RD # D11-6
GAINESVILLE FL
32610-0426
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7631
  • Fax: 352-273-6765
Mailing address:
  • Phone: 352-273-7631
  • Fax: 352-273-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDRPM2487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: