Healthcare Provider Details

I. General information

NPI: 1679265755
Provider Name (Legal Business Name): KYLE JOSEPH CRITELLI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4595 NORTHLAKE BLVD STE 103
PALM BEACH GARDENS FL
33418-4647
US

IV. Provider business mailing address

10600 NW 56TH CT
CORAL SPRINGS FL
33076-3105
US

V. Phone/Fax

Practice location:
  • Phone: 954-651-0887
  • Fax:
Mailing address:
  • Phone: 954-651-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: