Provider Demographics
NPI:1013277961
Name:GIES, KYLE FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:FREDERICK
Last Name:GIES
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 1:6123 HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-6728
Mailing Address - Country:US
Mailing Address - Phone:231-865-6945
Mailing Address - Fax:231-798-1150
Practice Address - Street 1:6123 HARVEY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-6728
Practice Address - Country:US
Practice Address - Phone:213-865-6945
Practice Address - Fax:231-798-1150
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010206451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice