Provider Demographics
NPI:1447303854
Name:RAYMOND, MICHAEL KYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KYLE
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5656 BEE CAVE RD
Mailing Address - Street 2:#B104
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-732-0022
Mailing Address - Fax:512-436-9240
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:#B104
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-732-0022
Practice Address - Fax:512-436-9240
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX18034OtherSTATE LICENSE NUMBER
TX090818802Medicaid
TX090818803Medicaid
TX090818802Medicaid