Provider Demographics
NPI:1629747498
Name:KYLE M. SMITH, D.D.S., P.A.
Entity Type:Organization
Organization Name:KYLE M. SMITH, D.D.S., P.A.
Other - Org Name:DENTAL SLEEP SOLUTIONS OF MCKINNEY
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-543-0563
Mailing Address - Street 1:4818 WELLINGTON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6010
Mailing Address - Country:US
Mailing Address - Phone:214-592-8042
Mailing Address - Fax:
Practice Address - Street 1:8751 COLLIN MCKINNEY PKWY STE 1502
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-0230
Practice Address - Country:US
Practice Address - Phone:214-592-8042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KYLE M. SMITH, D.D.S., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty