Provider Demographics
NPI:1598938458
Name:KISS, EDWARD PHILLIP (DMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:PHILLIP
Last Name:KISS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14315 62ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8664
Mailing Address - Country:US
Mailing Address - Phone:253-851-4025
Mailing Address - Fax:253-853-6352
Practice Address - Street 1:5012 58TH AVENUE CT W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3689
Practice Address - Country:US
Practice Address - Phone:253-566-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice