# OREGON PIP DENTAL GROUP, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** J. Kyle House, DDS, PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730412149
- **Authorized official:** MELLISSA RENNER (REGIONAL OPERATION MANAGER)
- **Authorized official phone:** (541) 571-7145

## Contact information

- **Practice address:** 419 STATE ST STE 4, HOOD RIVER, OR 97031-2075
- **Practice address phone:** (541) 387-8688
- **Practice address fax:** (541) 387-6785
- **Mailing address:** 419 STATE ST STE 4, HOOD RIVER, OR 97031-2075
- **Mailing address phone:** (541) 387-8688
- **Mailing address fax:** (541) 387-6785

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | D7666 | OR | Yes |

## Other

- **Enumeration date:** 09/16/2009
- **Last updated:** 10/07/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5036470 | — | WA |