Provider Demographics
NPI:1346400512
Name:DR KYLE R MOORE DDS
Entity Type:Organization
Organization Name:DR KYLE R MOORE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-665-2041
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:101 JAMESON DRIVE
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-0459
Mailing Address - Country:US
Mailing Address - Phone:405-665-2041
Mailing Address - Fax:405-665-2707
Practice Address - Street 1:101 JAMESON DRIVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098
Practice Address - Country:US
Practice Address - Phone:405-665-2041
Practice Address - Fax:405-665-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty