Provider Demographics
NPI:1841229002
Name:POPPLETON, KYLE DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:POPPLETON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SHOSHONE ST N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6364
Mailing Address - Country:US
Mailing Address - Phone:208-733-0695
Mailing Address - Fax:208-736-4540
Practice Address - Street 1:1001 SHOSHONE ST N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6364
Practice Address - Country:US
Practice Address - Phone:208-733-0695
Practice Address - Fax:208-736-4540
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-35541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice