Provider Demographics
NPI:1851820161
Name:CARTER, KYLE PAYNE (DMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:PAYNE
Last Name:CARTER
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 1:2904 E DOLPHIN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-3926
Mailing Address - Country:US
Mailing Address - Phone:480-229-9020
Mailing Address - Fax:
Practice Address - Street 1:2904 E DOLPHIN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-3926
Practice Address - Country:US
Practice Address - Phone:480-229-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty