Provider Demographics
NPI:1346693892
Name:KYLE BLAIR
Entity Type:Organization
Organization Name:KYLE BLAIR
Other - Org Name:COVINGTON FAMILY DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KLYE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-630-5500
Mailing Address - Street 1:17121 SE 270TH PL STE 202
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5431
Mailing Address - Country:US
Mailing Address - Phone:253-630-5500
Mailing Address - Fax:
Practice Address - Street 1:17121 SE 270TH PL STE 202
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5431
Practice Address - Country:US
Practice Address - Phone:253-630-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60170682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1245546068OtherNPI