Provider Demographics
NPI:1154202158
Name:FOUTZ, KYLE MARTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:MARTIN
Last Name:FOUTZ
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 1:2401 E 30TH ST BLDG 1
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8939
Mailing Address - Country:US
Mailing Address - Phone:505-327-0441
Mailing Address - Fax:505-324-9473
Practice Address - Street 1:2401 E 30TH ST BLDG 1
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8939
Practice Address - Country:US
Practice Address - Phone:505-327-0441
Practice Address - Fax:505-324-9473
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDB-2025-0179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist