| Peterson Periodontics & Implantology Llc | |
|
5528 Se Powell Blvd Portland OR 97206-2956 | |
| (503) 788-1008 | |
| Not Available |
| Full Name | Peterson Periodontics & Implantology Llc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 5528 Se Powell Blvd, Portland, Oregon |
| Authorized Official Name and Position | Andrew Gregory Peterson (PERIODONTIST, MEMBER OF LLC) |
| Authorized Official Contact | 4068618844 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peterson Periodontics & Implantology Llc 4420 Se 51st Ave Portland OR 97206-3910 Ph: (406) 861-8844 | Peterson Periodontics & Implantology Llc 5528 Se Powell Blvd Portland OR 97206-2956 Ph: (503) 788-1008 |
| NPI Number | 1801310008 |
|---|---|
| Provider Enumeration Date | 07/29/2017 |
| Last Update Date | 07/29/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801310008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | D9905 (Oregon) | Primary |
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