Kyle M Pett, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D11083 Issued in OR

Practice address

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051

Phone

(541) 479-6393

Fax

(541) 479-6489

NPI assigned

Jun 26, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• La Clinica del Valle Family Health Care Center Inc.

  dba East Medford Dental Clinic-La Clinica

  • Federally Qualified Health Center (FQHC)
  • Medford, OR
  • NPI 1891061784
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1790346013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-479-6393",
            "fax_number": "541-479-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-479-6393",
            "fax_number": "541-479-6489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1113 Progress Dr",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "975045201",
            "country_code": "US",
            "telephone_number": "541-512-3900",
            "fax_number": "541-414-1175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETT",
        "first_name": "KYLE",
        "middle_name": "M",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-26",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500764913",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marla Peters, MD
• Katie Petersen, CPM, LDM
• Paula M Peterson, LMT
• Samuel Nolan Peterson, AU.D.
• Kimberly Petetit
• Shawna Nichole Pfaendler
• Melissa Pfeifle, PHARMD
• Ashley Rhio Phaigh, LMT
• Kathy Dawn Phelps, RPH
• Neil Alan Phillips, D.O.

• Dentist in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.