Healthcare Provider Details

I. General information

NPI: 1922000595
Provider Name (Legal Business Name): KYLE K CATRON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 J T STITES BLVD
SALLISAW OK
74955-9302
US

IV. Provider business mailing address

1220 E UNIONTOWN ST
VAN BUREN AR
72956-8020
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-9150
  • Fax:
Mailing address:
  • Phone: 479-474-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4917
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: