Provider Demographics
NPI:1932321320
Name:ADAMS, KYLE WARREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WARREN
Last Name:ADAMS
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 1:12533 EMPTY DIGGINS
Mailing Address - Street 2:
Mailing Address - City:ROUGH & READY
Mailing Address - State:CA
Mailing Address - Zip Code:95975
Mailing Address - Country:US
Mailing Address - Phone:530-432-1635
Mailing Address - Fax:530-292-4296
Practice Address - Street 1:15301 TYLER FOOTE RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9318
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:530-292-4296
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA911759239OtherTIN