Kyle W Dimond, DDS
Individual provider Active NPI Dentist · Sweet Home, OR
NPI 1457666166 · NPPES record last updated Aug 18, 2010
Key facts
- NPI
- 1457666166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D9429 (OR)
- Practice address
- 1524 Long St
Sweet Home, OR 97386-2313 - Phone
- (541) 367-2931
- NPI assigned
- Aug 18, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9429 | OR | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D9429 | OR | Yes |
Addresses
Primary practice location
1524 Long St
Sweet Home, OR 97386-2313
Mailing address
1290 Evergreen LN
Sweet Home, OR 97386-1301
Phone (541) 818-0545
Other providers in Sweet Home, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.