Provider Demographics
NPI:1669688156
Name:SMITH, KYLE THOMAS (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:THOMAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 N. MOPAC
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-346-6097
Mailing Address - Fax:512-346-8135
Practice Address - Street 1:7800 N MO PAC EXPY
Practice Address - Street 2:SUITE 310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8900
Practice Address - Country:US
Practice Address - Phone:512-346-6097
Practice Address - Fax:512-346-8135
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202561223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720195498OtherCORPORATION