Provider Demographics
NPI:1457672602
Name:SMITS, KYLE ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
Last Name:SMITS
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 1:5647 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1588
Mailing Address - Country:US
Mailing Address - Phone:206-935-4611
Mailing Address - Fax:206-935-9235
Practice Address - Street 1:5647 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1588
Practice Address - Country:US
Practice Address - Phone:206-935-4611
Practice Address - Fax:206-935-9235
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601680491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice