Individual
KYLIE WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
3081 N HIGHWAY 97 STE 150, BEND, OR 97703-7569
(541) 797-9136
(458) 202-2218
Mailing address
3081 N HWY 97 STE 150, BEND, OR 97703-7569
(541) 797-9136
(458) 202-2218
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10789
OR
1223G0001X
General Practice Dentistry
D10789
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417484296
DENTIST, HEALTH CARE
OR
Enumeration date
05/11/2017
Last updated
12/05/2022
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