Provider Demographics
NPI:1821611534
Name:PENLAND, KYLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:PENLAND
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 1:2327 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA
Mailing Address - State:FL
Mailing Address - Zip Code:32168-8205
Mailing Address - Country:US
Mailing Address - Phone:386-957-5270
Mailing Address - Fax:
Practice Address - Street 1:2327 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8205
Practice Address - Country:US
Practice Address - Phone:386-957-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN248941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice