Provider Demographics
NPI:1760495154
Name:MCGILL, KYLE PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:PATRICK
Last Name:MCGILL
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 1:10 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:269-684-6003
Practice Address - Street 1:3915 STONEGATE PARK
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9130
Practice Address - Country:US
Practice Address - Phone:269-429-1515
Practice Address - Fax:269-429-1538
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010191671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice