Provider Demographics
NPI:1417443276
Name:LANTZ, KYLE THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:THOMAS
Last Name:LANTZ
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 1:1395 CENTER DR
Mailing Address - Street 2:ROOM #D1-17
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610
Mailing Address - Country:US
Mailing Address - Phone:352-273-5440
Mailing Address - Fax:352-273-5448
Practice Address - Street 1:1395 CENTER DR
Practice Address - Street 2:ROOM #D1-17
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610
Practice Address - Country:US
Practice Address - Phone:352-273-5440
Practice Address - Fax:352-273-5448
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4933122300000X
FLDRPM26011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist