Kyle Pettersen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN016137 Issued in GA

Practice address

3401 S Congress Ave Ste 206
Palm Springs, FL 33461-3066

Phone

(561) 366-2222

NPI assigned

Aug 19, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Florida Children'S Dentistry, P.a.

  • Pediatric Dentistry
  • Hialeah, FL
  • NPI 1972854149
  NPD (past)

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

{
    "created_epoch": "1282176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776556800000",
    "number": "1275849986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 S CONGRESS AVE STE 206",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334613066",
            "telephone_number": "561-366-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 S CONGRESS AVE STE 206",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334613066",
            "telephone_number": "561-366-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSEN",
        "first_name": "KYLE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-19",
        "last_updated": "2026-04-19",
        "certification_date": "2026-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "59547",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN016137",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "0025983",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ismael Perez
• Manuel Alejandro Perez
• Rolando Perez, LCSW
• Yadira Perez
• Micheline G Petit, FNP
• Pharmacy Choice Inc
• John Phelps
• Physical Therapy Now of Lake Worth Inc
• Physicians Consortium Group LLC
• Physrehab Inc

• General Practice Dentistry in Palm Springs, FL
• Providers in Palm Springs, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2026; 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.