Provider Demographics
NPI:1346543220
Name:KYLE VALENTINE DMD PC
Entity Type:Organization
Organization Name:KYLE VALENTINE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-254-5593
Mailing Address - Street 1:10000 SE MAIN ST STE 20
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2461
Mailing Address - Country:US
Mailing Address - Phone:503-254-5593
Mailing Address - Fax:503-253-3878
Practice Address - Street 1:10000 SE MAIN ST STE 20
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2461
Practice Address - Country:US
Practice Address - Phone:503-254-5593
Practice Address - Fax:503-253-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD91461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty