Healthcare Provider Details

I. General information

NPI: 1548622632
Provider Name (Legal Business Name): KYLE DILUZIO MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 HENSLEE DR
DICKSON TN
37055-2166
US

IV. Provider business mailing address

445 HENSLEE DR
DICKSON TN
37055-2166
US

V. Phone/Fax

Practice location:
  • Phone: 615-441-1441
  • Fax: 615-697-6546
Mailing address:
  • Phone: 615-441-1441
  • Fax: 615-697-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11822
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: