Provider Demographics
NPI:1780199562
Name:KYLE TAYLOR, DDS II, PLLC
Entity Type:Organization
Organization Name:KYLE TAYLOR, DDS II, PLLC
Other - Org Name:TRANQUIL BAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-560-3582
Mailing Address - Street 1:16621 JETTON RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7441
Mailing Address - Country:US
Mailing Address - Phone:704-560-3582
Mailing Address - Fax:
Practice Address - Street 1:2415 PENNY RD STE 203
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8123
Practice Address - Country:US
Practice Address - Phone:704-560-3582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-03
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5190261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental