# ALL CITY DENTURE CLINIC PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366755613
- **Authorized official:** WALTER JAMES PETERSON DT-DO (EMPLOYER)
- **Authorized official phone:** (503) 760-8409

## Contact information

- **Practice address:** 12661 SE POWELL BLVD, SUITE B, PORTLAND, OR 97236-3400
- **Practice address phone:** (503) 760-8409
- **Practice address fax:** (503) 760-8577
- **Mailing address:** 12661 SE POWELL BLVD, SUITE B, PORTLAND, OR 97236-3400
- **Mailing address phone:** (503) 760-8409
- **Mailing address fax:** (503) 760-8577

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | DTDO949472 | OR | Yes |

## Other

- **Enumeration date:** 07/15/2010
- **Last updated:** 07/15/2010