Healthcare Provider Details

I. General information

NPI: 1538380191
Provider Name (Legal Business Name): WILLIAM GREGORY KAYLAKIE D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11615 ANGUS RD #113
AUSTIN TX
78759
US

IV. Provider business mailing address

11615 ANGUS RD #113
AUSTIN TX
78759
US

V. Phone/Fax

Practice location:
  • Phone: 512-794-2822
  • Fax: 512-349-0818
Mailing address:
  • Phone: 512-794-2822
  • Fax: 512-349-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number14527
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: