Healthcare Provider Details

I. General information

NPI: 1700561081
Provider Name (Legal Business Name): KALIN PAUL VORWALLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 HOPPE BLVD
ADA OK
74820-2322
US

IV. Provider business mailing address

1529 HOPPE BLVD
ADA OK
74820-2322
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-0431
  • Fax:
Mailing address:
  • Phone: 580-332-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39652
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39652
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: