Individual
DR. CARLY CHRISTOFERSON PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3900 DOUGLAS WAY, LAKE OSWEGO, OR 97035-3446
(503) 636-8446
(503) 636-4446
Mailing address
3900 DOUGLAS WAY, LAKE OSWEGO, OR 97035-3446
(503) 636-8446
(503) 636-4446
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11110
OR
Other
Enumeration date
08/01/2019
Last updated
03/01/2022
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