Provider Demographics
NPI:1821581232
Name:PIHA, KYLE ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ANDREW
Last Name:PIHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11907 LISMORE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7424
Mailing Address - Country:US
Mailing Address - Phone:941-447-9519
Mailing Address - Fax:
Practice Address - Street 1:5330 E MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-0940
Practice Address - Country:US
Practice Address - Phone:214-821-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34085OtherDENTAL LICENSE #