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General NPI Number Information
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NPI Number | 1790346013
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Entity Type | Individual
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Provider Name | KYLE M PETT DMD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 1701 NW HAWTHORNE AVE
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City | GRANTS PASS
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State | OR
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Zip | 97526-1051
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Country | US
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Telephone | 541-479-6393
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Fax | 541-479-6489
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Provider Business Mailing Address
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Address Line | 1701 NW HAWTHORNE AVE
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City | GRANTS PASS
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State | OR
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Zip | 97526-1051
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Country | US
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Telephone | 541-479-6393
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Fax | 541-479-6489
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11083
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License Number State | OR
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