Provider Demographics
NPI:1326884206
Name:MANROSS, KYLE (DMD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MANROSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-5029
Mailing Address - Country:US
Mailing Address - Phone:803-727-7906
Mailing Address - Fax:
Practice Address - Street 1:1222 N PINES RD STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6444
Practice Address - Country:US
Practice Address - Phone:509-924-0381
Practice Address - Fax:509-893-9485
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE615603941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice