Provider Demographics
NPI:1134569254
Name:YERTON, KYLE A (DMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:A
Last Name:YERTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1408
Mailing Address - Country:US
Mailing Address - Phone:813-354-9424
Mailing Address - Fax:813-849-0211
Practice Address - Street 1:5200 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1408
Practice Address - Country:US
Practice Address - Phone:813-354-9424
Practice Address - Fax:813-849-0211
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist