Provider Demographics
NPI:1639869258
Name:ZUMFELDE, KYLE SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:SCOTT
Last Name:ZUMFELDE
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 1:3158 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2055
Mailing Address - Country:US
Mailing Address - Phone:614-362-6411
Mailing Address - Fax:
Practice Address - Street 1:3158 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2055
Practice Address - Country:US
Practice Address - Phone:614-362-6411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0271341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice