Individual
DR. KYLE EDWARD DETAVERNIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5900 W CHESTER RD STE A, WEST CHESTER, OH 45069-2951
(513) 942-8181
Mailing address
11463 ARROWHEAD DR, SOUTH LYON, MI 48178-9541
(248) 921-2484
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901600250
MI
122300000X
Dentist
Primary
30.025935
OH
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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