Provider Demographics
NPI:1639539356
Name:W. KYLE DIXON, DDS, PLLC
Entity Type:Organization
Organization Name:W. KYLE DIXON, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-524-6145
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-0548
Mailing Address - Country:US
Mailing Address - Phone:479-524-6145
Mailing Address - Fax:479-524-2967
Practice Address - Street 1:509 S MOUNT OLIVE ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3625
Practice Address - Country:US
Practice Address - Phone:479-524-6145
Practice Address - Fax:479-524-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty