Individual
GARY THEODORE PEDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1565 LIBERTY ST SE, SALEM, OR 97302-4345
(503) 581-0223
(503) 581-6794
Mailing address
1565 LIBERTY ST SE, SALEM, OR 97302-4345
(503) 581-0223
(503) 581-6794
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D4658
OR
Other
Enumeration date
07/14/2005
Last updated
07/17/2007
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