Individual
KYLE M PETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1051
(541) 479-6393
(541) 479-6489
Mailing address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1051
(541) 479-6393
(541) 479-6489
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11083
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500764913
—
OR
Enumeration date
06/26/2019
Last updated
01/26/2023
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