Provider Demographics
NPI:1730856774
Name:KAISKY
Entity type:Organization
Organization Name:KAISKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-857-7026
Mailing Address - Street 1:1230 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-5203
Mailing Address - Country:US
Mailing Address - Phone:503-981-3603
Mailing Address - Fax:503-981-3604
Practice Address - Street 1:2550 NE MCDONALD LN
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2223
Practice Address - Country:US
Practice Address - Phone:503-472-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental