Provider Demographics
NPI:1083908255
Name:KEPLER, KYLE COLEMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:COLEMAN
Last Name:KEPLER
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 1:5601 NE ANTIOCH RD STE 5
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2375
Mailing Address - Country:US
Mailing Address - Phone:816-455-1200
Mailing Address - Fax:
Practice Address - Street 1:5601 NE ANTIOCH RD STE 5
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-2375
Practice Address - Country:US
Practice Address - Phone:816-455-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011015043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist