| Kyle D Sullivan, Dmd, Pllc | |
|
121 W Poplar St Ste A Walla Walla WA 99362-2871 | |
| (509) 525-3522 | |
| (509) 525-0518 |
| Full Name | Kyle D Sullivan, Dmd, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 121 W Poplar St Ste A, Walla Walla, Washington |
| Authorized Official Name and Position | Kyle Sullivan (OWNER/DENTIST) |
| Authorized Official Contact | 5095253522 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kyle D Sullivan, Dmd, Pllc 121 W Poplar St Ste A Walla Walla WA 99362-2871 Ph: (509) 525-3522 | Kyle D Sullivan, Dmd, Pllc 121 W Poplar St Ste A Walla Walla WA 99362-2871 Ph: (509) 525-3522 |
| NPI Number | 1346718244 |
|---|---|
| Provider Enumeration Date | 11/08/2018 |
| Last Update Date | 11/08/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346718244 | NPI | - | NPPES |
| 122300000X | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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