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General NPI Number Information
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NPI Number | 1154202158
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Entity Type | Individual
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Provider Name | KYLE MARTIN FOUTZ DDS
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Gender | Male
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 2401 E 30TH ST BLDG 1
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City | FARMINGTON
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State | NM
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Zip | 87401-8939
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Country | US
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Telephone | 505-327-0441
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Fax | 505-324-9473
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Provider Business Mailing Address
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Address Line | 2401 E 30TH ST BLDG 1
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City | FARMINGTON
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State | NM
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Zip | 87401-8939
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Country | US
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Telephone | 505-327-0441
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Fax | 505-324-9473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DB-2025-0179
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License Number State | NM
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