Provider Demographics
NPI:1043446214
Name:WALK, KYLE ARCHER (DMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ARCHER
Last Name:WALK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DRAVOSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15034-1013
Mailing Address - Country:US
Mailing Address - Phone:412-466-4347
Mailing Address - Fax:412-466-7720
Practice Address - Street 1:510 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:DRAVOSBURG
Practice Address - State:PA
Practice Address - Zip Code:15034-1013
Practice Address - Country:US
Practice Address - Phone:412-466-4347
Practice Address - Fax:412-466-7720
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022450L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice