Provider Demographics
NPI:1366782674
Name:WAIT, KYLE LAINE (DDS)
Entity type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:LAINE
Last Name:WAIT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:KYLE
Other - Middle Name:LAINE
Other - Last Name:GAWRYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10181 N 92ND ST
Mailing Address - Street 2:UNIT 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-391-9009
Mailing Address - Fax:480-391-9029
Practice Address - Street 1:10181 N 92ND ST
Practice Address - Street 2:UNIT 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-391-9009
Practice Address - Fax:480-391-9029
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61591223G0001X
AZD0089071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice