Kyle D Sullivan, DMD, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KYLE D SULLIVAN, DMD, PLLC

Practice address

121 W Poplar St Ste a
Walla Walla, WA 99362-2871

Phone

(509) 525-3522

Fax

(509) 525-0518

NPI assigned

Nov 8, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyle Sullivan, DMDNPI 1962558106

Title

Owner/Dentist

Phone

(509) 525-3522

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sullivan Family Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle Sullivan, DMD

  • General Practice Dentistry
  • Walla Walla, WA
  • NPI 1962558106
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541635200000",
    "number": "1346718244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 W POPLAR ST STE A",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622871",
            "telephone_number": "509-525-3522",
            "fax_number": "509-525-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W POPLAR ST STE A",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622871",
            "telephone_number": "509-525-3522",
            "fax_number": "509-525-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KYLE D SULLIVAN, DMD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-08",
        "last_updated": "2018-11-08",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "509-525-3522",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122300000X",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christine S Kruger, LPN, HOME HEALTH LLC
• Christine A Krugh, LICSW
• Haley Lynne Krupa, RDN
• Kuei Ghorbanian PLLC
• Kumo Acupuncture and Oriental Medicine
• L. Jenae Henry
• Susan Laabs, RN
• Laboratory Corporation of America
• Laboratory Corporation of America
• Laboratory Corporation of America

• Dental Clinic/Center in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.