Provider Demographics
NPI:1073806550
Name:MASON, KYLE CYRUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:CYRUS
Last Name:MASON
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 1:1440 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1633
Mailing Address - Country:US
Mailing Address - Phone:719-346-7746
Mailing Address - Fax:
Practice Address - Street 1:1440 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1633
Practice Address - Country:US
Practice Address - Phone:719-346-7746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088371223G0001X
CODEN2019001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice