Individual
DANIEL PETRISOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8916
(503) 494-6783
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8916
(503) 494-6783
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D9059
OR
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD154906
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0022923-00
—
FL
01
—
148H9
BCBS FL
FL
05
—
500651136
—
OR
05
—
500654224
—
OR
01
—
BP1-0026540
INSTITUTIONAL PERMIT
—
Enumeration date
06/09/2007
Last updated
07/16/2025
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