Provider Demographics
NPI:1255328209
Name:DOSCH, KYLE PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:PAUL
Last Name:DOSCH
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 1:1512 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3320
Mailing Address - Country:US
Mailing Address - Phone:208-667-4024
Mailing Address - Fax:
Practice Address - Street 1:1512 N 6TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3320
Practice Address - Country:US
Practice Address - Phone:208-667-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist