Provider Demographics
NPI:1407860646
Name:BAXLEY, WILLIAM KYLE SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KYLE
Last Name:BAXLEY
Suffix:SR
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 1:4320 E LUCAS DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-5500
Mailing Address - Country:US
Mailing Address - Phone:409-892-2208
Mailing Address - Fax:409-892-4110
Practice Address - Street 1:4320 E LUCAS DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-5500
Practice Address - Country:US
Practice Address - Phone:409-892-2208
Practice Address - Fax:409-892-4110
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice