Provider Demographics
NPI:1871189241
Name:BENTLEY, KYLE DAVIS
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVIS
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 EMERALD BAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3284
Mailing Address - Country:US
Mailing Address - Phone:214-923-1763
Mailing Address - Fax:
Practice Address - Street 1:1855 EMERALD BAY DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3284
Practice Address - Country:US
Practice Address - Phone:214-923-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No156F00000XEye and Vision Services ProvidersTechnician/Technologist