Provider Demographics
NPI:1548371917
Name:KYLE, KEITH WESTON (DDS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WESTON
Last Name:KYLE
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 1:1102 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-3606
Mailing Address - Country:US
Mailing Address - Phone:409-886-0335
Mailing Address - Fax:409-886-0337
Practice Address - Street 1:1102 N 16TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-3606
Practice Address - Country:US
Practice Address - Phone:409-886-0335
Practice Address - Fax:409-886-0337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice