Provider Demographics
NPI:1407936180
Name:EBERLEIN, KYLE DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DAVID
Last Name:EBERLEIN
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 1:556 W BEDFORD EULESS RD STE E
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3924
Mailing Address - Country:US
Mailing Address - Phone:817-282-9321
Mailing Address - Fax:817-282-9759
Practice Address - Street 1:556 W BEDFORD EULESS RD STE E
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3924
Practice Address - Country:US
Practice Address - Phone:817-282-9321
Practice Address - Fax:817-282-9759
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice