Provider Demographics
NPI:1639528540
Name:NEUSCHAEFER, KYLE JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JAMES
Last Name:NEUSCHAEFER
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 1:31 OFALLON SQ
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3034
Mailing Address - Country:US
Mailing Address - Phone:636-240-1750
Mailing Address - Fax:
Practice Address - Street 1:31 OFALLON SQ
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366
Practice Address - Country:US
Practice Address - Phone:636-240-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001346-15122300000X
MO2019008752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist