Healthcare Provider Details

I. General information

NPI: 1689073660
Provider Name (Legal Business Name): RICHARD GREGORY PYLE DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W UNIVERSITY AVE
MUNCIE IN
47303-3863
US

IV. Provider business mailing address

800 W UNIVERSITY AVE
MUNCIE IN
47303-3863
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-6121
  • Fax: 765-282-8706
Mailing address:
  • Phone: 765-288-6121
  • Fax: 765-282-8706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009262
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number12009262
License Number StateIN

VIII. Authorized Official

Name: DR. RICHARD GREGORY PYLE
Title or Position: OWNER
Credential: DDS
Phone: 765-288-6121