MEDICARE: KYLE TAYLOR, DDS II, PLLC

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	261QD0000X	Dental Clinic/Center	5190	NC

General Provider Information

NPI Number	:	1780199562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KYLE TAYLOR, DDS II, PLLC

Provider Business Mailing Address
First Line	:	16621 JETTON RD
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-7441
Country	:	US
Telephone Number	:	704-560-3582
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 PENNY RD STE 203
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8123
Country	:	US
Telephone Number	:	704-560-3582
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYLE WILSON TAYLOR
Credential	:	DDS
Telephone Number	:	704-560-3582

Provider Enumeration Date	:	12/03/2017
Last Update Date	:	12/03/2017

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