Individual
KYLE COUNTRYMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4421 LONG PRAIRIE RD STE 400, FLOWER MOUND, TX 75028-1752
(972) 691-3636
Mailing address
2003 NW 57TH ST UNIT 304, SEATTLE, WA 98107-5538
(903) 340-7943
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
34996
TX
Other
Enumeration date
09/19/2018
Last updated
10/01/2019
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