Provider Demographics
NPI:1871127274
Name:KYLE WASHUT, DDS, PLLC
Entity type:Organization
Organization Name:KYLE WASHUT, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-697-4666
Mailing Address - Street 1:203 W YAKIMA AVE
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1337
Mailing Address - Country:US
Mailing Address - Phone:509-833-6419
Mailing Address - Fax:
Practice Address - Street 1:203 W YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1337
Practice Address - Country:US
Practice Address - Phone:509-697-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental