Individual
KYLE S WYLDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
137 DAMASCUS RD, MARYSVILLE, OH 43040-9618
(937) 644-8822
Mailing address
1220 SASSAFRAS LN, MARYSVILLE, OH 43040-8032
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30-023918
OH
1223G0001X
General Practice Dentistry
Primary
30-023918
OH
Other
Enumeration date
05/17/2013
Last updated
03/17/2018
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