Organization
KYLE NOVOTNY DDS PLLC
Active
Other names
Legacy Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE STEPHEN NOVOTNY DDS (OWNER)
(763) 757-1323
Entity
Organization
Contact information
Practice address
12265 CENTRAL AVE NE, BLAINE, MN 55434-3961
(763) 757-1323
(763) 757-1037
Mailing address
12265 CENTRAL AVE NE, BLAINE, MN 55434-3961
(763) 757-1323
(763) 757-1037
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/29/2022
Last updated
12/29/2022
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