=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801417654
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLE ARMSTRONG DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2020
-----------------------------------------------------
Last Update Date | 09/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 GRANT AVE
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13021-1404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-515-3015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 83 NEW YORK AVE
-----------------------------------------------------
City | FREEPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11520-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-635-3688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 062146
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------