Provider Demographics
NPI:1407531981
Name:KILPATRICK, KYLE RICHARD II (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:RICHARD
Last Name:KILPATRICK
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 ROCKY POINT LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8481
Mailing Address - Country:US
Mailing Address - Phone:803-372-8315
Mailing Address - Fax:
Practice Address - Street 1:1100 VILLAGE HARBOR DR
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-9091
Practice Address - Country:US
Practice Address - Phone:803-831-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.105411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice