Provider Demographics
NPI:1780378661
Name:DENNIS, KYLE S (DMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:S
Last Name:DENNIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 SHELBYVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3212
Mailing Address - Country:US
Mailing Address - Phone:502-896-1032
Mailing Address - Fax:
Practice Address - Street 1:4122 SHELBYVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3212
Practice Address - Country:US
Practice Address - Phone:502-896-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11211122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist