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Organization
ALL CITY DENTURE CLINIC PC
Active
Organization
ALL CITY DENTURE CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER JAMES PETERSON DT-DO (EMPLOYER)
(503) 760-8409
Entity
Organization
Contact information
Practice address
12661 SE POWELL BLVD, SUITE B, PORTLAND, OR 97236-3400
(503) 760-8409
(503) 760-8577
Mailing address
12661 SE POWELL BLVD, SUITE B, PORTLAND, OR 97236-3400
(503) 760-8409
(503) 760-8577
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
DTDO949472
OR
Other
Enumeration date
07/15/2010
Last updated
07/15/2010
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