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General NPI Number Information
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NPI Number | 1588549760
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Entity Type | Organization
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Legal Business Name | KYLE HOLLIS OF CONCORD, PLLC
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 9900 POPLAR TENT RD STE 150
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City | CONCORD
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State | NC
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Zip | 28027-9516
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Country | US
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Telephone | 704-782-2402
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Fax |
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Provider Business Mailing Address
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Address Line | 9900 POPLAR TENT RD STE 150
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City | CONCORD
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State | NC
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Zip | 28027-9516
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Country | US
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Telephone | 704-782-2402
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PAYOR CONTRACTS
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Name | CASEY CASTLE
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Credential |
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Telephone | 912-732-1504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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