MEDICARE: KYLE LESTER PABUSTAN VILORIA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10442	NC

General Provider Information

NPI Number	:	1346600376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE LESTER PABUSTAN VILORIA D.D.S.

Provider Business Mailing Address
First Line	:	9550 ROCKY RIVER RD STE 202
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-9592
Country	:	US
Telephone Number	:	704-496-9001
Fax Number	:	855-254-9601

Provider Business Practice Location Address
First Line	:	9550 ROCKY RIVER RD STE 202
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-9526
Country	:	US
Telephone Number	:	704-496-9001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	09/26/2022

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