Healthcare Provider Details

I. General information

NPI: 1730537440
Provider Name (Legal Business Name): KYLE ESTELLE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 ANDERSON AVE
CLIFFSIDE PARK NJ
07010-1811
US

IV. Provider business mailing address

351 7TH ST APT 1L
JERSEY CITY NJ
07302-1838
US

V. Phone/Fax

Practice location:
  • Phone: 201-945-1119
  • Fax:
Mailing address:
  • Phone: 631-252-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02660800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDR02970
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: