Provider Demographics
NPI:1851679948
Name:THAMES, KYLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:THAMES
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 1:6950 NE CAMPUS WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5611
Mailing Address - Country:US
Mailing Address - Phone:503-952-2164
Mailing Address - Fax:503-952-2267
Practice Address - Street 1:1107 NE BURNSIDE RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5710
Practice Address - Country:US
Practice Address - Phone:503-665-9616
Practice Address - Fax:503-666-0852
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist