Provider Demographics
NPI:1457380198
Name:KYLE, MARK A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:KYLE
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 1:6801 MAYFIELD RD
Mailing Address - Street 2:SUITE 246
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2208
Mailing Address - Country:US
Mailing Address - Phone:440-449-0300
Mailing Address - Fax:440-449-0300
Practice Address - Street 1:6801 MAYFIELD RD
Practice Address - Street 2:SUITE 246
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2208
Practice Address - Country:US
Practice Address - Phone:440-449-0300
Practice Address - Fax:440-449-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6160360001Medicare NSC
OHU-12962Medicare UPIN
OHKY0689101Medicare PIN