Provider Demographics
NPI:1588920920
Name:KYLES, CHRISTOPHER WILLIAM (DMD, MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:KYLES
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12236 SE 35TH CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-8600
Mailing Address - Country:US
Mailing Address - Phone:360-927-2508
Mailing Address - Fax:
Practice Address - Street 1:400 E MCLEOD RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5535
Practice Address - Country:US
Practice Address - Phone:360-746-6492
Practice Address - Fax:360-746-6390
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD97961223S0112X
WAWA608510361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery