Provider Demographics
NPI:1801286869
Name:KYLE GRINDLING DDS P.C.
Entity type:Organization
Organization Name:KYLE GRINDLING DDS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:CHANDLER
Authorized Official - Last Name:GRINDLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-467-7627
Mailing Address - Street 1:2951 N CLARK ST
Mailing Address - Street 2:APT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5203
Mailing Address - Country:US
Mailing Address - Phone:248-467-7627
Mailing Address - Fax:
Practice Address - Street 1:2951 N CLARK ST
Practice Address - Street 2:APT 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5203
Practice Address - Country:US
Practice Address - Phone:248-467-7627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-027982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty