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General NPI Number Information
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NPI Number | 1528544517
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Entity Type | Individual
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Provider Name | ANDREA M KYRO
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Gender | Female
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 4919 OUTER LOOP
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City | LOUISVILLE
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State | KY
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Zip | 40219-4051
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Country | US
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Telephone | 502-907-1092
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Fax |
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Provider Business Mailing Address
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Address Line | 113 ORCHARD HILLS DR APT 267
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-8299
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Country | US
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Telephone | 812-987-8920
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Fax |
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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 | 10149
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License Number State | KY
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