Provider Demographics
NPI:1962045880
Name:DIEHL, KYLE (PHD, DDS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:DIEHL
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 OLD RAIL WAY
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8753
Mailing Address - Country:US
Mailing Address - Phone:720-633-7875
Mailing Address - Fax:
Practice Address - Street 1:2979 IOLA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3193
Practice Address - Country:US
Practice Address - Phone:720-703-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204086122300000X
CO2040861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics