MEDICARE: KYLE SCOTT ZUMFELDE DDS

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	30.027134	OH

General Provider Information

NPI Number	:	1639869258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE SCOTT ZUMFELDE DDS

Provider Business Mailing Address
First Line	:	3158 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2055
Country	:	US
Telephone Number	:	614-362-6411
Fax Number	:

Provider Business Practice Location Address
First Line	:	3158 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2055
Country	:	US
Telephone Number	:	614-362-6411
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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