Individual
DR. KYLE D. FAGALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.S.
Contact information
Practice address
2176 WEST ST, SUITE 320, GERMANTOWN, TN 38138-3869
(870) 761-4800
Mailing address
2176 WEST ST, SUITE 320, GERMANTOWN, TN 38138-3869
(870) 761-4800
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
9553
TN
Other
Enumeration date
03/08/2013
Last updated
03/08/2013
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