Provider Demographics
NPI:1730490434
Name:SCOTT, KYLE STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:STEVEN
Last Name:SCOTT
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 1:3499 E MELODY LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1729
Mailing Address - Country:US
Mailing Address - Phone:480-707-3667
Mailing Address - Fax:
Practice Address - Street 1:1455 E GUADALUPE RD STE 1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3951
Practice Address - Country:US
Practice Address - Phone:480-831-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8674122300000X
CA59543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist