Provider Demographics
NPI:1457521072
Name:KYLE W. TAYLOR, D.D.S., P.A,
Entity Type:Organization
Organization Name:KYLE W. TAYLOR, D.D.S., P.A,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:704-548-1818
Mailing Address - Street 1:2315 W ARBORS DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2577
Mailing Address - Country:US
Mailing Address - Phone:704-548-1818
Mailing Address - Fax:704-548-1126
Practice Address - Street 1:2315 W ARBORS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2577
Practice Address - Country:US
Practice Address - Phone:704-548-1818
Practice Address - Fax:704-548-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905870Medicaid
NC5906019Medicaid