Provider Demographics
NPI:1407076078
Name:WALKER, KYLE MATHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:MATHEW
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-4951
Mailing Address - Country:US
Mailing Address - Phone:409-883-8887
Mailing Address - Fax:
Practice Address - Street 1:1402 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4951
Practice Address - Country:US
Practice Address - Phone:409-883-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist