Individual
JULIAN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1050 W ELM AVE, SUITE 230, HERMISTON, OR 97838-2700
(888) 468-0022
(541) 504-3907
Mailing address
PO BOX 490, REDMOND, OR 97756-0092
(888) 468-0022
(541) 504-3907
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9292
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500607644
—
OR
Enumeration date
06/30/2009
Last updated
10/03/2011
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