Provider Demographics
NPI:1730783895
Name:KRINGLE, KYLE JACOB (DMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JACOB
Last Name:KRINGLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:KYLE
Other - Middle Name:JACOB
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1196 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-5518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 E MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4429
Practice Address - Country:US
Practice Address - Phone:662-453-1708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4172-201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice