Provider Demographics
NPI:1548713126
Name:KYLE A. SMITS DDS PLLC
Entity type:Organization
Organization Name:KYLE A. SMITS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SMITS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-935-4611
Mailing Address - Street 1:5647 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1588
Mailing Address - Country:US
Mailing Address - Phone:206-935-4611
Mailing Address - Fax:
Practice Address - Street 1:5647 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1588
Practice Address - Country:US
Practice Address - Phone:206-935-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60168049261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental