Provider Demographics
NPI:1891567806
Name:CLOVE, KAYSON TYLER
Entity Type:Individual
Prefix:
First Name:KAYSON
Middle Name:TYLER
Last Name:CLOVE
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 1:51ST MEDICAL GROUP, 777 SONGTAN BLVD
Mailing Address - Street 2:UNIT 2060
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96278
Mailing Address - Country:US
Mailing Address - Phone:315-784-0228
Mailing Address - Fax:
Practice Address - Street 1:51ST MEDICAL GROUP, 777 SONGTAN BLVD
Practice Address - Street 2:UNIT 2060
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96278
Practice Address - Country:US
Practice Address - Phone:315-784-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant