Healthcare Provider Details

I. General information

NPI: 1154253235
Provider Name (Legal Business Name): KYLE DYNES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 WHIPPLE AVE NW
CANTON OH
44718-4805
US

IV. Provider business mailing address

138 BANK LN APT C
DOVER OH
44622-1972
US

V. Phone/Fax

Practice location:
  • Phone: 234-214-9731
  • Fax:
Mailing address:
  • Phone: 330-291-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: