Healthcare Provider Details

I. General information

NPI: 1689536864
Provider Name (Legal Business Name): SMILE BY KYLE LLC, DBA BRIELLE HILLS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 ROUTE 70 STE 2D
MANASQUAN NJ
08736-2610
US

IV. Provider business mailing address

2640 ROUTE 70 STE 2D
MANASQUAN NJ
08736-2610
US

V. Phone/Fax

Practice location:
  • Phone: 732-223-2334
  • Fax:
Mailing address:
  • Phone: 732-223-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: KENNETH DITMARS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 732-736-9100