Kyle M Shull, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2011016320 Issued in MO

Practice address

2601 Range Line St Ste 111
Columbia, MO 65202

Phone

(573) 355-5870

Fax

(573) 355-5887

NPI assigned

Apr 7, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1982993267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 RANGE LINE ST STE 111",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652021618",
            "telephone_number": "573-355-5870",
            "fax_number": "573-355-5887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 RANGE LINE ST STE 111",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "65202",
            "telephone_number": "573-355-5870",
            "fax_number": "573-355-5887"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3400 W Truman Blvd",
            "address_purpose": "LOCATION",
            "city": "Jefferson City",
            "state": "MO",
            "postal_code": "651095712",
            "country_code": "US",
            "telephone_number": "573-632-2777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHULL",
        "first_name": "KYLE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-07",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2011016320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ramsey O Shouman, DDS
• Seth Showalter, LCSW
• Beth Gia Shoyer, PH.D.
• Adekemi Shoyinka, PHARMD
• Drishti Shrestha
• Jonathan Shumway, DO
• Stepan Pavlovich Shumyak, DO
• Faisal Shurafa
• Nancy Ann Sibert, RPH
• Bracy Ann Sickal, RN

• Dentist in Columbia, MO
• Providers in Columbia, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.