Kyle Benjamin Bader, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

30.027112 Issued in OH

Practice address

6441 Winchester Blvd
Canal Winchester, OH 43110-2033

Phone

(614) 834-3455

NPI assigned

May 8, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• devoted network organization-9f3dfbd3-4aa6-4c92-8e71-9c4ed35ce037
• devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
• KY PPO C-SNP
• devoted network organization-8ee96498-f86e-45f6-9fc9-a0f06c1636f9

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1003506643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4712 BROOK RUN",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435609264",
            "telephone_number": "419-467-0994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6441 WINCHESTER BLVD",
            "city": "CANAL WINCHESTER",
            "state": "OH",
            "postal_code": "431102033",
            "telephone_number": "614-834-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADER",
        "first_name": "KYLE",
        "middle_name": "BENJAMIN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-08",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.027112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Canal Winchester, OH
• Providers in Canal Winchester, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.