Organization
PETERSON PERIODONTICS & IMPLANTOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW GREGORY PETERSON DMD, MS (PERIODONTIST, MEMBER OF LLC)
(406) 861-8844
Entity
Organization
Contact information
Practice address
5528 SE POWELL BLVD, PORTLAND, OR 97206-2956
(503) 788-1008
Mailing address
4420 SE 51ST AVE, PORTLAND, OR 97206-3910
(406) 861-8844
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D9905
OR
Other
Enumeration date
07/29/2017
Last updated
07/29/2017
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