Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 08413 | IA |
NPI | 1043423395 |
---|---|
Provider Name | Dr. Kyle Robert Mann |
First Address | Grimes, IA 50111-8861 |
Second Address | Grimes, IA 50111-8861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 16/12/2020 |