Active NPI
Kyle O'Connor, DDS
- Dentist
- Centralia, WA
National Provider Identifier
1134735277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE61085949
- Practice address
- 2401 Borst Ave
Centralia, WA 98531-1411 - Phone
- (360) 736-1151
- NPI assigned
- Sep 22, 2020
- Last updated
- Sep 22, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE61085949 | WA | Primary |
Addresses
Primary practice location
2401 Borst Ave
Centralia, WA 98531-1411
Mailing address
132A Pleasant Hill Rd
Chehalis, WA 98532-9112
Phone (360) 480-3759
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE61085949 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600732800000",
"number": "1134735277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "132A PLEASANT HILL RD",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "985329112",
"telephone_number": "360-480-3759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 BORST AVE",
"city": "CENTRALIA",
"state": "WA",
"postal_code": "985311411",
"telephone_number": "360-736-1151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'CONNOR",
"first_name": "KYLE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-22",
"last_updated": "2020-09-22",
"certification_date": "2020-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE61085949",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centralia, WA
- Northwest Country Place, Inc (Liberty Country Place)
- Northwest Healthcare Alliance, Inc. (Assured Home Health & Hospice)
- Northwest Healthcare Alliance, Inc. (Assured Home Health & Hospice)
- Jeremy Glenn Nugent, CM60686561
- Archibald Nyamekye, CRNA
- Patrick O'Neill, MD
- Robert Francis Oatfield, D.O.
- Jamila Dahir Obsiye
- Kerry M Oconnor, DDS
- Staci Lynette Ogden
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.