Individual
DR. CYNTHIA MARION PETICOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
548 S 1ST AVE, MILL CITY, OR 97360
(503) 897-2353
(503) 897-2354
Mailing address
PO BOX 260, MILL CITY, OR 97360
(503) 897-2353
(503) 897-2354
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5986
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265439
—
OR
Enumeration date
03/31/2006
Last updated
05/26/2015
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