Provider Demographics
NPI:1902160955
Name:BURGMEIER, KYLE ROBERT (DDS)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:ROBERT
Last Name:BURGMEIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KYLE
Other - Middle Name:ROBERT
Other - Last Name:BURGMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2800 4TH ST SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401
Mailing Address - Country:US
Mailing Address - Phone:641-423-0064
Mailing Address - Fax:641-421-7544
Practice Address - Street 1:2800 4TH ST SW
Practice Address - Street 2:ST. 1
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-423-0064
Practice Address - Fax:641-421-7544
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08959122300000X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0228379Medicaid