Provider Demographics
NPI:1932891595
Name:KYLE DOROSH DMD
Entity Type:Organization
Organization Name:KYLE DOROSH DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOROSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-954-3905
Mailing Address - Street 1:10121 N NEVADA ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-3120
Mailing Address - Country:US
Mailing Address - Phone:509-467-1000
Mailing Address - Fax:509-467-1001
Practice Address - Street 1:10121 N NEVADA ST STE 301
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3120
Practice Address - Country:US
Practice Address - Phone:509-467-1000
Practice Address - Fax:509-467-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty