Healthcare Provider Details

I. General information

NPI: 1437728326
Provider Name (Legal Business Name): KYLE DUNN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KYLE ALLAN DUNN

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W285N7383 BARK RIVER RD
HARTLAND WI
53029-8326
US

IV. Provider business mailing address

408 GINGER BEND DR APT 103
CHAMPAIGN IL
61822-3555
US

V. Phone/Fax

Practice location:
  • Phone: 920-539-8036
  • Fax:
Mailing address:
  • Phone: 920-539-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6002097
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: