Healthcare Provider Details

I. General information

NPI: 1649074618
Provider Name (Legal Business Name): KYLE MCKELVEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MISSILE AVE
MINOT AFB ND
58705-5003
US

IV. Provider business mailing address

10 MISSILE AVE
MINOT AFB ND
58705-5003
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5633
  • Fax:
Mailing address:
  • Phone: 701-723-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: