MEDICARE: DR. KYLE HODGES 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	122300000X	Dentist	7657	NV
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S3-397	NV

General Provider Information

NPI Number	:	1245975697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE HODGES DMD

Provider Business Mailing Address
First Line	:	600 N CARRIAGE HILL DR UNIT 1039
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-4739
Country	:	US
Telephone Number	:	757-303-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4203
Country	:	US
Telephone Number	:	702-674-7000
Fax Number	:

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

Provider Enumeration Date	:	04/30/2022
Last Update Date	:	07/29/2025

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