Healthcare Provider Details

I. General information

NPI: 1124874433
Provider Name (Legal Business Name): KYLIE J SCOTT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 LININGER LN # B
NORTH LIBERTY IA
52317-2316
US

IV. Provider business mailing address

1738 LININGER LN # B
NORTH LIBERTY IA
52317-2316
US

V. Phone/Fax

Practice location:
  • Phone: 319-472-7224
  • Fax:
Mailing address:
  • Phone: 319-472-7224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS-10236
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: