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General NPI Number Information
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NPI Number | 1134367360
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Entity Type | Organization
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Legal Business Name | KEITH R. KYLER, D.D.S., L.L.C.
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 01/26/2009
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Provider Practice Location Address
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Address Line | 11964 COURSEY BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70816-4405
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Country | US
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Telephone | 225-292-8010
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Fax | 225-291-6341
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Provider Business Mailing Address
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Address Line | 11964 COURSEY BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70816-4405
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Country | US
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Telephone | 225-292-8010
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Fax | 225-291-6341
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH RAY KYLER
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Credential | D.D.S.
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Telephone | 225-292-8010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4362
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License Number State | LA
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