MEDICARE: KYLE ALBA

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	DN31993	FL

General Provider Information

NPI Number	:	1104504281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ALBA

Provider Business Mailing Address
First Line	:	345 E 24TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-4020
Country	:	US
Telephone Number	:	212-998-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5316 CENTRAL FLORIDA PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-8772
Country	:	US
Telephone Number	:	407-239-9556
Fax Number	:

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

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	06/25/2026

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