Kyle Pediatric Dental

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

24217 Issued in TX

Legal business name

KYLE PEDIATRIC DENTAL

Practice address

575 E FM 150
Suite P
Kyle, TX 78640-6200

Phone

(512) 442-4338

NPI assigned

Sep 18, 2014

Organization subpart

No

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

Authorized official

Name

Marty Montgomery, D.M.D.

Title

President

Phone

(512) 574-6923

Specialties & licenses 1

Addresses

Other names 1

• Lone Star Pediatric Dental Doing business as

Locations

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1679975932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 S 1ST ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787045421",
            "telephone_number": "512-442-4338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 E FM 150",
            "address_2": "SUITE P",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406200",
            "telephone_number": "512-442-4338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KYLE PEDIATRIC DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2014-09-18",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "MARTY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-574-6923",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "24217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Star Pediatric Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kyle Dental and Braces PLLC
• Kyle ER LLC
• Kyle Family Eye Care
• Kyle Ip, PLLC
• Kyle Microendodontics
• Kyle Vision PLLC
• Emily Jeanne Lain, D.C.
• Katarina Lane, LMFTA
• Senoah Langford
• Brandon Langle, PHARMD, RPH

• All providers in Kyle, TX
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; 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.