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General NPI Number Information
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NPI Number | 1245546068
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Entity Type | Individual
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Provider Name | KYLE SCOTT BLAIR D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 17121 SE 270TH PL SUITE 202
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City | COVINGTON
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State | WA
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Zip | 98042-5431
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Country | US
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Telephone | 253-630-5500
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Fax | 253-630-2930
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Provider Business Mailing Address
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Address Line | 17121 SE 270TH PL SUITE #202
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City | COVINGTON
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State | WA
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Zip | 98042-5431
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Country | US
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Telephone | 253-630-5500
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Fax | 253-630-2930
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE 60170682
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License Number State | WA
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