Provider Demographics
NPI:1710401021
Name:MEASON, KYLE EVAN
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:EVAN
Last Name:MEASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 FORT WORTH HWY STE 600
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4786
Mailing Address - Country:US
Mailing Address - Phone:817-341-7825
Mailing Address - Fax:817-594-7835
Practice Address - Street 1:2035 FORT WORTH HWY STE 600
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-341-7825
Practice Address - Fax:817-594-7835
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics