Active NPI
Kyle Klooster, MD, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Detroit, MI
National Provider Identifier
1053608752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 2901020443
- Practice address
- 7633 E Jefferson Ave
Suite 70
Detroit, MI 48214-3730 - Phone
- (313) 499-4775
- Fax
- (313) 499-4953
- NPI assigned
- Jul 1, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 2901020443 | MI | Primary |
Addresses
Primary practice location
7633 E Jefferson Ave
Suite 70
Detroit, MI 48214-3730
Mailing address
7633 E Jefferson Ave
Suite 70
Detroit, MI 48214-3730
Phone (313) 499-4775
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 11, 2024 through Sep 11, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901020443 | MI | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459209600000",
"number": "1053608752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7633 E JEFFERSON AVE",
"address_2": "SUITE 70",
"city": "DETROIT",
"state": "MI",
"postal_code": "482143730",
"telephone_number": "313-499-4775",
"fax_number": "313-499-4953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7633 E JEFFERSON AVE",
"address_2": "SUITE 70",
"city": "DETROIT",
"state": "MI",
"postal_code": "482143730",
"telephone_number": "313-499-4775",
"fax_number": "313-499-4953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLOOSTER",
"first_name": "KYLE",
"credential": "MD, DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-01",
"last_updated": "2016-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "MI",
"license": "2901020443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.