Provider Demographics
NPI:1619661360
Name:MAYER, KYLE NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:NICHOLAS
Last Name:MAYER
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 1:3369 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6610
Mailing Address - Country:US
Mailing Address - Phone:810-922-7258
Mailing Address - Fax:
Practice Address - Street 1:25631 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4434
Practice Address - Country:US
Practice Address - Phone:586-775-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016016771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice