Kyle Proctor, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

110631 Issued in CA

Practice address

940 Sylva LN Ste K2
Sonora, CA 95370-5969

Phone

(209) 536-8600

NPI assigned

Aug 22, 2024

Sex

Male

Sole proprietor

Yes

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

• Mathiesen Memorial Health Center

  • Primary Care Clinic/Center
  • Jamestown, CA
  • NPI 1356080022
  NPD
• Mathiesen Memorial Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Jamestown, CA
  • NPI 1255595484
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kyle.proctor.p1@direct.mathiesenmemorialhc.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2024.

{
    "created_epoch": "1724284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1811720162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 535",
            "city": "JAMESTOWN",
            "state": "CA",
            "postal_code": "953270535",
            "telephone_number": "209-984-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 SYLVA LN STE K2",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705969",
            "telephone_number": "209-536-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18144 Seco St",
            "address_purpose": "LOCATION",
            "city": "Jamestown",
            "state": "CA",
            "postal_code": "953279498",
            "country_code": "US",
            "telephone_number": "209-984-4820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-08-22",
        "last_updated": "2024-08-22",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "110631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Pierce
• Timothy Pilchard, MSPT
• Michael Richard Portillo, M.D.
• Dennis L Potapchuk
• Heather Price, PA-C
• Janelle Quin
• Ralph E Retherford MD Inc
• Ron E Rankin, DDS
• Vincent Paul Rapini
• Robert Zachary Rasco, DDS

• All providers in Sonora, CA
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.