Provider Demographics
NPI:1689790602
Name:KYLER, KEITH R (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:R
Last Name:KYLER
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 1:11964 COURSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4405
Mailing Address - Country:US
Mailing Address - Phone:225-292-8010
Mailing Address - Fax:225-291-6341
Practice Address - Street 1:11964 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4405
Practice Address - Country:US
Practice Address - Phone:225-292-8010
Practice Address - Fax:225-291-6341
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics