Individual provider Active NPI

Kyle Filicetti

  • Dentist
  • Phoenix, AZ
National Provider Identifier
1649107731
Registry record updated Jun 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D012887 Issued in AZ
Practice address
25155 N 67TH Ave Ste 142
Phoenix, AZ 85083-1065
Phone
(623) 561-6767
NPI assigned
May 5, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D012887 AZ Primary

Addresses

Primary practice location

25155 N 67TH Ave Ste 142
Phoenix, AZ 85083-1065

Mailing address

25155 N 67TH Ave Ste 142
Phoenix, AZ 85083-1065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1777939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782345600000",
    "number": "1649107731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25155 N 67TH AVE STE 142",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850831065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25155 N 67TH AVE STE 142",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850831065",
            "telephone_number": "623-561-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FILICETTI",
        "first_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-05-05",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D012887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.