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NPI Code Detail

MEDICARE: DR. MARK A KYLE D.D.S.

MEDICARE: DR. MARK A KYLE D.D.S.
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
11223G0001XGeneral Practice Dentistry17104OH

General Provider Information

NPI Number : 1457380198
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK A KYLE D.D.S.
Provider Business Mailing Address
First Line : 6801 MAYFIELD RD
Second Line : SUITE 246
City : MAYFIELD HEIGHTS
State : OH
Zip : 44124-2208
Country : US
Telephone Number : 440-449-0300
Fax Number : 440-449-0300
Provider Business Practice Location Address
First Line : 6801 MAYFIELD RD
Second Line : SUITE 246
City : MAYFIELD HEIGHTS
State : OH
Zip : 44124-2208
Country : US
Telephone Number : 440-449-0300
Fax Number : 440-449-0300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 05/20/2009

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