Basic Information
| Provider Information | |||||||||
| NPI: | 1316329618 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILSON | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2303 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645064954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162326818 | ||||||||
| FaxNumber: | 8162322991 | ||||||||
| Practice Location | |||||||||
| Address1: | 3608 FARAON ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645063044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163646444 | ||||||||
| FaxNumber: | 8163646929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2015 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 2015019041 | MO | Y | Dental Providers | Dentist | General Practice |
No ID Information.