Kyle Winston Tubb, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4066-19 Issued in MS

Practice address

1763 Cliff Gookin Blvd
Tupelo, MS 38801-6723

Phone

(662) 842-2802

NPI assigned

Jun 10, 2019

Last updated

Jun 10, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• LD-Tupelo, LLC

  dba Premier Dental

  • Dental Clinic/Center
  • Tupelo, MS
  • NPI 1760995963
  NPD (past)

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1982263380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 JOYNER AVE",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388041844",
            "telephone_number": "662-315-9686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1763 CLIFF GOOKIN BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016723",
            "telephone_number": "662-842-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUBB",
        "first_name": "KYLE",
        "middle_name": "WINSTON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-10",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4066-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Eugene Trotter, MD
• Mary Trout
• Trucare Sitters LLC
• Cameron Tubb
• Heather Tubb
• Abby Ruth Tucker, M.ED.
• Emily A Tucker, FNP-BC
• Emily Williams Tuggle, PT
• Tupelo Anesthesia Group PA
• Tupelo Children's Mansion, Inc.

• General Practice Dentistry in Tupelo, MS
• Providers in Tupelo, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; 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.