Active NPI
Kyle Andrew Krall, D.D.S.
- Dentist
- Metamora, IL
National Provider Identifier
1891043907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 19-025832
- Practice address
- 212 N Davenport St
Metamora, IL 61548-9395 - Phone
- (309) 367-2378
- NPI assigned
- Aug 21, 2012
- Last updated
- Aug 21, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19-025832 | IL | Primary |
Addresses
Primary practice location
212 N Davenport St
Metamora, IL 61548-9395
Mailing address
212 N Davenport St
PO Box 920
Metamora, IL 61548-9395
Phone (309) 367-2378
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19-025832 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Krallyoder PC | Current | Accepting new patients |
Locations
212 N Davenport St
Metamora, IL 61548
Phone (309) 367-2378
Organizations & group practices 1
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": "1345507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345507200000",
"number": "1891043907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 N DAVENPORT ST",
"address_2": "PO BOX 920",
"city": "METAMORA",
"state": "IL",
"postal_code": "615489395",
"telephone_number": "309-367-2378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 N DAVENPORT ST",
"city": "METAMORA",
"state": "IL",
"postal_code": "615489395",
"telephone_number": "309-367-2378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRALL",
"first_name": "KYLE",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-21",
"last_updated": "2012-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "19-025832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Metamora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.