Provider Demographics
NPI:1326354226
Name:KYLE TANAKA DDS PLLC
Entity type:Organization
Organization Name:KYLE TANAKA DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-776-2126
Mailing Address - Street 1:19320 40TH AVE W
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4602
Mailing Address - Country:US
Mailing Address - Phone:425-776-2126
Mailing Address - Fax:425-670-8177
Practice Address - Street 1:19320 40TH AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4602
Practice Address - Country:US
Practice Address - Phone:425-776-2126
Practice Address - Fax:425-670-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty