Provider Demographics
NPI:1063639375
Name:KEETER, KYLE GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:GLENN
Last Name:KEETER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 PRESTON RD STE 255
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6217
Mailing Address - Country:US
Mailing Address - Phone:214-360-0055
Mailing Address - Fax:214-360-0066
Practice Address - Street 1:8201 PRESTON RD STE 255
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6217
Practice Address - Country:US
Practice Address - Phone:214-360-0055
Practice Address - Fax:214-360-0066
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist