Provider Demographics
NPI:1578810537
Name:KYLE WALKINGTON, DDS, PLLC
Entity Type:Organization
Organization Name:KYLE WALKINGTON, DDS, PLLC
Other - Org Name:WILDFLOWER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-372-0150
Mailing Address - Street 1:7447 HILLCREST RD STE 106
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6203
Mailing Address - Country:US
Mailing Address - Phone:989-372-0150
Mailing Address - Fax:
Practice Address - Street 1:7447 HILLCREST RD STE 106
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6203
Practice Address - Country:US
Practice Address - Phone:989-372-0150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty