Provider Demographics
NPI:1700561081
Name:VORWALLER, KALIN PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KALIN
Middle Name:PAUL
Last Name:VORWALLER
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 1:2917 GILCHRIST DR
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-3869
Mailing Address - Country:US
Mailing Address - Phone:801-336-6040
Mailing Address - Fax:
Practice Address - Street 1:824 HEWITT DR STE 300
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6604
Practice Address - Country:US
Practice Address - Phone:254-207-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX396521223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice