MEDICARE: KYLE PELKEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8626	CO

General Provider Information

NPI Number	:	1093937559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE PELKEY DMD

Provider Business Mailing Address
First Line	:	4102 PINION DR
Second Line	:
City	:	USAF ACADEMY
State	:	CO
Zip	:	80840-2502
Country	:	US
Telephone Number	:	719-333-5051
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIVERSITY OF COLORADO SCHOOL OF DENTAL MEDICINE
Second Line	:	13065 E 17TH AVE
City	:	AURORA
State	:	CO
Zip	:	80045-0000
Country	:	US
Telephone Number	:	303-724-7112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/04/2021

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