Provider Demographics
NPI:1619182995
Name:STUART, KYLE JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JOSEPH
Last Name:STUART
Suffix:
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:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:MC INTOSH
Mailing Address - State:FL
Mailing Address - Zip Code:32664-0455
Mailing Address - Country:US
Mailing Address - Phone:352-463-2665
Mailing Address - Fax:352-463-6848
Practice Address - Street 1:216 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3427
Practice Address - Country:US
Practice Address - Phone:352-463-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 146671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice