Kyle Wilburn

Primary specialty

DentistTaxonomy code 122300000X

License

106843 Issued in CA

Practice address

4755 Hoen Ave
Santa Rosa, CA 95405-7862

Phone

(707) 542-2881

NPI assigned

Mar 24, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1326675984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 HOEN AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057862",
            "telephone_number": "707-542-2881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 HOEN AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057862",
            "telephone_number": "707-542-2881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBURN",
        "first_name": "KYLE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "106843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katharine Wignall, RN
• Wilber & Associates
• Heather Wilber
• Richard Wilber, MD
• Frank Ray Wilbur, D.C.
• Steven Charles Wilburn, DMD
• Michael Warren Wilcox, M.A., M.A.
• Jacqueline Michael Wilde, LMFT
• Michael Bernard Wilder, D.C.
• Zoe Book Wilder, LCSW

• Dentist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.