Healthcare Provider Details

I. General information

NPI: 1841784832
Provider Name (Legal Business Name): KYLE DIRENZO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 S HURON PKWY
ANN ARBOR MI
48104-5151
US

IV. Provider business mailing address

1734 BARRINGTON PL
ANN ARBOR MI
48103-5607
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-2156
  • Fax: 734-704-0006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901022658
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: