Organization
PETERSON ORTHODONTICS & PERIODONTICS, LLC
Active
Organization
PETERSON ORTHODONTICS & PERIODONTICS, LLC
Active
Other names
Lake Oswego Orthodontics & Periodontics, Lake Oswego Orthodontics, Lake Oswego Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VANESSA N B PETERSON DDS, MS (ORTHODONTIST, MEMBER OF LLC)
(909) 518-7743
Entity
Organization
Contact information
Practice address
15962 BOONES FERRY RD STE 108, LAKE OSWEGO, OR 97035-4359
(503) 699-6569
Mailing address
4420 SE 51ST AVE, PORTLAND, OR 97206-3910
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
—
OR
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
OR
Other
Enumeration date
07/28/2017
Last updated
06/16/2018
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