Provider Demographics
NPI:1457339905
Name:KAY, R. MARLIN (DDS)
Entity Type:Individual
Prefix:
First Name:R.
Middle Name:MARLIN
Last Name:KAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-1090
Mailing Address - Country:US
Mailing Address - Phone:360-458-5606
Mailing Address - Fax:
Practice Address - Street 1:718 W YELM AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9412
Practice Address - Country:US
Practice Address - Phone:360-458-5606
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA49421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice