Provider Demographics
NPI:1912373242
Name:KYLE TAYLOR DDS PLLC
Entity Type:Organization
Organization Name:KYLE TAYLOR DDS PLLC
Other - Org Name:DISTINCTIVELY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-560-3582
Mailing Address - Street 1:4622 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3769
Mailing Address - Country:US
Mailing Address - Phone:704-560-3582
Mailing Address - Fax:
Practice Address - Street 1:4622 COUNTRY CLUB RD
Practice Address - Street 2:STE. 280
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3769
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:2015-08-20
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty