Provider Demographics
NPI:1245546068
Name:BLAIR, KYLE SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:SCOTT
Last Name:BLAIR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17121 SE 270TH PL
Mailing Address - Street 2:SUITE #202
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:253-630-2930
Practice Address - Street 1:17121 SE 270TH PL
Practice Address - Street 2:SUITE 202
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:253-630-2930
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60170682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist