Provider Demographics
NPI:1316430721
Name:PERKINS, KYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:PERKINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KYLE
Other - Middle Name:
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1600 2ND AVE SW STE 21
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3459
Mailing Address - Country:US
Mailing Address - Phone:701-839-1705
Mailing Address - Fax:
Practice Address - Street 1:268 W 400 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1831
Practice Address - Country:US
Practice Address - Phone:801-855-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10844452-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist