Kylie Wasserman, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D10789 Issued in OR

Practice address

3081 N Highway 97 Ste 150
Bend, OR 97703-7569

Phone

(541) 797-9136

Fax

(458) 202-2218

NPI assigned

May 11, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Three Sisters Sleep LLC

  • Customized Equipment (DME)
  • Bend, OR
  • NPI 1609523166

  Dentist

  NPD Authorized official

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1417484296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3081 N HWY 97 STE 150",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037569",
            "telephone_number": "541-797-9136",
            "fax_number": "458-202-2218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3081 N HIGHWAY 97 STE 150",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037569",
            "telephone_number": "541-797-9136",
            "fax_number": "458-202-2218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16461 William Foss Rd",
            "address_purpose": "LOCATION",
            "city": "LA Pine",
            "state": "OR",
            "postal_code": "977399486",
            "country_code": "US",
            "telephone_number": "541-907-7020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WASSERMAN",
        "first_name": "KYLIE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-11",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D10789",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D10789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST, HEALTH CARE",
            "identifier": "1417484296",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Brooke Warton, DO
• Anne Sophia Harris Warzecha
• Brennan Myerle Washburn, CADC-R, CRM, PSS
• Cynthia Washburn
• Jennifer Wass
• Dana Louise Waterbury, RDH EPDH
• Charlotte Ela Watership, OTR/L
• Natalie Jade Watkowski
• Watson Integrative Wellness
• Amanda Louise Watson, LMT

• Dentist in Bend, OR
• Providers in Bend, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.