Provider Demographics
NPI:1821722281
Name:SCHWARTZ, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19839 SE BORNSTEDT RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-6676
Mailing Address - Country:US
Mailing Address - Phone:510-730-0251
Mailing Address - Fax:
Practice Address - Street 1:504 TIMMONS ST
Practice Address - Street 2:
Practice Address - City:SCOBEY
Practice Address - State:MT
Practice Address - Zip Code:59263-7871
Practice Address - Country:US
Practice Address - Phone:406-487-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-23714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist