Provider Demographics
NPI:1386375137
Name:NITTLER, KAYLA-ANN
Entity type:Individual
Prefix:
First Name:KAYLA-ANN
Middle Name:
Last Name:NITTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 ASH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-1044
Mailing Address - Country:US
Mailing Address - Phone:405-920-8446
Mailing Address - Fax:
Practice Address - Street 1:1617 E DANFORTH RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3103
Practice Address - Country:US
Practice Address - Phone:405-330-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice