Provider Demographics
NPI:1225254212
Name:KEITH, BYRON KYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:KYLE
Last Name:KEITH
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 1:5989 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2028
Mailing Address - Country:US
Mailing Address - Phone:314-725-1555
Mailing Address - Fax:314-725-4453
Practice Address - Street 1:5989 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-2028
Practice Address - Country:US
Practice Address - Phone:314-725-1555
Practice Address - Fax:314-725-4453
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO138441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice