Provider Demographics
NPI:1336643337
Name:TUTTLE, KYLE COLLEDGE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:COLLEDGE
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 N 4100 W
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84404-8093
Mailing Address - Country:US
Mailing Address - Phone:435-253-0376
Mailing Address - Fax:
Practice Address - Street 1:1508 E SKYLINE DR STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4849
Practice Address - Country:US
Practice Address - Phone:801-627-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002045771223X0400X
390200000X
UT11841617-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program