Healthcare Provider Details

I. General information

NPI: 1205203825
Provider Name (Legal Business Name): KYLE TANGNEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 COMPTON RD UNIT 9
CINCINNATI OH
45231-3846
US

IV. Provider business mailing address

800 COMPTON RD UNIT 9
CINCINNATI OH
45231-3846
US

V. Phone/Fax

Practice location:
  • Phone: 513-521-2100
  • Fax:
Mailing address:
  • Phone: 513-521-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021619
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.026426
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: