Individual provider Active NPI

Kyle T Reynolds, D.D.S.

  • Pediatric Dentistry
  • Lubbock, TX
National Provider Identifier
1699061473
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
35767 Issued in TX
Practice address
809 N Frankford Ave
Lubbock, TX 79416-1568
Phone
(806) 796-2408
Fax
(806) 686-6246
NPI assigned
Jun 21, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DEN.00203233 CO
Pediatric Dentistry 1223P0221X 35767 TX Primary

Addresses

Primary practice location

809 N Frankford Ave
Lubbock, TX 79416-1568

Mailing address

809 N Frankford Ave
Lubbock, TX 79416-1568
Phone (806) 796-2408

Other practice location 1

7815 Quaker Ave
Lubbock, TX 79424-3363
Phone (806) 796-2408

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180420001385 CO Practitioner - DentistPractitioner - Other (Physician) 8527284322 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35767TXMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Denver Health and Hospital Authority CurrentSince Mar 5, 2018 Accepting new patients
Denver Health and Hospital Authority CurrentSince Mar 5, 2018 Accepting new patients
Parkview Pediatric Dental Holdings, PLLC Pediatric Dentistry Past Accepting new patients

Locations

777 Bannock St
#3240
Denver, CO 80204
Phone (303) 602-2714

777 Bannock St
Denver, CO 80204

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1699061473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 N FRANKFORD AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794161568",
            "telephone_number": "806-796-2408",
            "fax_number": "806-686-6246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 N FRANKFORD AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794161568",
            "telephone_number": "806-796-2408",
            "fax_number": "806-686-6246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7815 Quaker Ave",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794243363",
            "country_code": "US",
            "telephone_number": "806-796-2408",
            "fax_number": "806-686-6246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "KYLE",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-21",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "DEN.00203233",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "35767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.