MEDICARE: DR. JERALD KYLE HOUSE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	D7666	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710989827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERALD KYLE HOUSE D.D.S.

Provider Business Mailing Address
First Line	:	419 STATE ST
Second Line	:	STE 4
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-2075
Country	:	US
Telephone Number	:	541-387-8688
Fax Number	:	541-387-6785

Provider Business Practice Location Address
First Line	:	419 STATE ST
Second Line	:	STE 4
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-2075
Country	:	US
Telephone Number	:	541-387-8688
Fax Number	:	541-387-6785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/09/2007

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