Provider Demographics
NPI:1962138792
Name:ROZELLE, KYLIE DAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:DAYNE
Last Name:ROZELLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:DAYNE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3123 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6119
Mailing Address - Country:US
Mailing Address - Phone:931-484-3664
Mailing Address - Fax:
Practice Address - Street 1:3123 MILLER AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6119
Practice Address - Country:US
Practice Address - Phone:931-484-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist