Provider Demographics
NPI:1609179472
Name:NORMAN, KYLE J
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:NORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3495
Mailing Address - Country:US
Mailing Address - Phone:517-272-4150
Mailing Address - Fax:517-272-4150
Practice Address - Street 1:5303 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3800
Practice Address - Country:US
Practice Address - Phone:517-887-4311
Practice Address - Fax:517-887-4310
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist