NPIMap

Organization Active NPI

Krallyoder PC

Doing business as Metamora Family Dental

  • General Practice Dentistry
  • Metamora, IL
National Provider Identifier
1891957726
Registry record updated May 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025832 Issued in IL
Legal business name
KRALLYODER PC
Doing business as
Metamora Family Dental
Practice address
212 N Davenport St
Metamora, IL 61548-9395
Phone
(309) 369-2378
NPI assigned
Jul 1, 2008
Last updated
May 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2022

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

Authorized official

Name
Dr. Kyle Andrew Krall, DDSNPI 1891043907
Title
President
Phone
(309) 367-2378

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
General Practice Dentistry 1223G0001X 019018768 IL
General Practice Dentistry 1223G0001X 019025832 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) 369-2378

Other names 1

  • Metamora Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

212 N Davenport St
Metamora, IL 61548
Phone (309) 367-2378

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1891957726",
    "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": "309-369-2378"
        },
        {
            "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": "309-369-2378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRALLYODER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-01",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "KRALL",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-367-2378",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019018768",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metamora Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 4, 2022; 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.