=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487362422
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KYLE NIELD DDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2022
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 OWINGS ST
-----------------------------------------------------
City | LAURENS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29360-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-984-6888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 OWING ST
-----------------------------------------------------
City | LAURENS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-629-0302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | KYLE NIELD
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 540-629-0302
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------