Provider Demographics
NPI:1336744820
Name:BOSS ORTHO KYLE PLLC
Entity Type:Organization
Organization Name:BOSS ORTHO KYLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MHA
Authorized Official - Phone:512-640-4289
Mailing Address - Street 1:844 KOHLERS XING STE 220
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2475
Mailing Address - Country:US
Mailing Address - Phone:512-640-4289
Mailing Address - Fax:
Practice Address - Street 1:844 KOHLERS XING STE 220
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2475
Practice Address - Country:US
Practice Address - Phone:512-640-4289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty