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General NPI Number Information
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NPI Number | 1861053407
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Entity Type | Individual
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Provider Name | KYLE BRENT MANN DMD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 428 HUSTONVILLE ST
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City | LIBERTY
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State | KY
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Zip | 42539-3140
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Country | US
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Telephone | 606-787-2688
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Fax | 606-787-2687
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Provider Business Mailing Address
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Address Line | PO BOX 99
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City | COLUMBIA
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State | KY
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Zip | 42728-0099
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Country | US
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Telephone | 606-787-2688
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Fax | 606-787-2687
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10304
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License Number State | KY
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