Provider Demographics
NPI:1932827896
Name:KYLE MCGILL DDS PC
Entity Type:Organization
Organization Name:KYLE MCGILL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-684-6003
Mailing Address - Street 1:10 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2295
Mailing Address - Country:US
Mailing Address - Phone:269-684-6003
Mailing Address - Fax:
Practice Address - Street 1:10 N STATE ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2295
Practice Address - Country:US
Practice Address - Phone:269-684-6003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental