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Organization
FAMILY DENTAL CLINIC
Active
Organization
FAMILY DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES G. PETERSEN (OWNER/DENTIST)
(541) 447-3855
Entity
Organization
Contact information
Practice address
607 NE 3RD ST, PRINEVILLE, OR 97754-2021
(541) 447-3855
(541) 416-9580
Mailing address
607 NE 3RD ST, PRINEVILLE, OR 97754-2021
(541) 447-3855
(541) 416-9580
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10117
OR
Other
Enumeration date
08/12/2014
Last updated
08/12/2014
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