Provider Demographics
NPI:1114491529
Name:KYLE TAYLOR, DDS III, PLLC
Entity Type:Organization
Organization Name:KYLE TAYLOR, DDS III, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-560-3582
Mailing Address - Street 1:16621 JETTON RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7441
Mailing Address - Country:US
Mailing Address - Phone:704-560-3582
Mailing Address - Fax:
Practice Address - Street 1:3015 MAPLEWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4075
Practice Address - Country:US
Practice Address - Phone:704-560-3582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental