MEDICARE: DR. KYLE RUSSELL O'DONNELL 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
1	1223G0001X	General Practice Dentistry	6313	NV
2	122300000X	Dentist	DEN.00201989	CO

General Provider Information

NPI Number	:	1982957775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE RUSSELL O'DONNELL D.D.S.

Provider Business Mailing Address
First Line	:	200 W COUNTY LINE RD STE 210
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2342
Country	:	US
Telephone Number	:	702-338-5991
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W COUNTY LINE RD STE 210
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2342
Country	:	US
Telephone Number	:	303-791-0413
Fax Number	:

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

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	08/31/2020

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Directions to “ DR. KYLE RUSSELL O'DONNELL D.D.S.” Practice Location

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