MEDICARE: DR. KYLER CAMPBELL 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	122300000X	Dentist	D011879	AZ

General Provider Information

NPI Number	:	1730867805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLER CAMPBELL DDS

Provider Business Mailing Address
First Line	:	15010 S 40TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-6701
Country	:	US
Telephone Number	:	801-564-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 E RAY RD STE 115
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4705
Country	:	US
Telephone Number	:	480-706-6165
Fax Number	:

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

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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