Kyle Bosk, DMD
Individual provider Active NPI General Practice Dentistry · Gladstone, MI
NPI 1104230804 · NPPES record last updated Nov 21, 2024
Key facts
- NPI
- 1104230804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2901021293 (MI)
- Practice address
- 1103 Delta Ave
Gladstone, MI 49837-1438 - Phone
- (906) 428-1616
- Fax
- (906) 428-2177
- NPI assigned
- Jun 20, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 12, 2016 through Jan 12, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gallery B Smiles | General Practice | Current |
Accepting new patients |
| Escanaba Smile Center PLLC | Past | Accepting new patients | |
| Dr Paul J Jacobs DDS PC | Past |
Accepting new patients |
Locations
1103 Delta Ave
Gladstone, MI 49837
Phone (906) 428-1616
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901021293 | MI | Yes |
Addresses
Primary practice location
1103 Delta Ave
Gladstone, MI 49837-1438
Mailing address
1103 Delta Ave
Gladstone, MI 49837-1438
Phone (906) 428-1616
Other providers in Gladstone, MI
- Richard Blakeslee Ballard
- Bay de Noc Chiropractic Center, P.C.
- Beacon Specialized Living Services
- Bellin Health Iron Mountain Inc
- Pamela Sue Bialik
- Kevin Lawrence Boudreau
- Paul Bracket
- Brittany Bradway
- Jessica M Cameron
- DB Therapy LLC
All providers in Gladstone, MI · General Practice Dentistry in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.