Individual
PETER DENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16455 BOONES FERRY RD STE B, LAKE OSWEGO, OR 97035-4367
(503) 482-7200
Mailing address
0720 SW GAINES ST UNIT 213, PORTLAND, OR 97239-4650
(360) 751-2921
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2019-00625
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D9916
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
MD198730
OR
Other
Enumeration date
04/03/2013
Last updated
06/15/2020
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