Kyle Edward Detavernier, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

30.025935 Issued in OH

Practice address

5900 W Chester Rd Ste a
West Chester, OH 45069-2951

Phone

(513) 942-8181

NPI assigned

Aug 6, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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.

• West Chester Dental Group

  • General Practice Dentistry
  • West Chester, OH
  • NPI 1821146911
  NPD (past)
• Columbia Pike Family Dentistry

  • General Practice Dentistry
  • Arlington, VA
  • NPI 1497029631
  NPD (past)

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

{
    "created_epoch": "1565049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565049600000",
    "number": "1508411653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11463 ARROWHEAD DR",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481789541",
            "telephone_number": "248-921-2484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 W CHESTER RD STE A",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450692951",
            "telephone_number": "513-942-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETAVERNIER",
        "first_name": "KYLE",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-06",
        "last_updated": "2019-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901600250",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.025935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dentistry at University Pointe
• Kathryn Noel Depp, CCC-SLP
• Theresa M Derickson, MD
• Dermatology & Skin Care Associates
• Tamika Deshields
• Anne Deters, P.T
• Richard Deutch, O.D.
• Dever Dental LLC
• Martha Gerdsen Dever, DDS
• Hailey Deyhle, ARNP

• Dentist in West Chester, OH
• Providers in West Chester, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; 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.