Individual
PETER DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10300 SE WASHINGTON ST STE C101, PORTLAND, OR 97216-2805
(503) 776-3091
Mailing address
1204 SE 34TH AVE, PORTLAND, OR 97214-4222
(712) 560-6260
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
61039600
WA
1223P0221X
Pediatric Dentistry
Primary
D11970
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2018
Last updated
09/09/2024
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