Provider Demographics
NPI:1235427063
Name:STANLEY, KYLE GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:GREGORY
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S HOPE ST APT 221
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1492
Mailing Address - Country:US
Mailing Address - Phone:714-357-8130
Mailing Address - Fax:714-777-6734
Practice Address - Street 1:1000 S HOPE ST APT 221
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1492
Practice Address - Country:US
Practice Address - Phone:714-357-8130
Practice Address - Fax:714-777-6734
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice