Provider Demographics
NPI:1780069385
Name:POUPART, KYLE ZACHARY (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ZACHARY
Last Name:POUPART
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 1:13355 DALLAS PKWY
Mailing Address - Street 2:STE 400
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033
Mailing Address - Country:US
Mailing Address - Phone:972-798-2404
Mailing Address - Fax:
Practice Address - Street 1:13355 DALLAS PKWY
Practice Address - Street 2:STE 400
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033
Practice Address - Country:US
Practice Address - Phone:972-798-2404
Practice Address - Fax:972-798-2405
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31216122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist