GARY THEODORE PEDERSON


Address: 1565 Liberty St Se, Salem, OR 97302-4345
Phone: 5035810223

GARY THEODORE PEDERSON (NPI# 1447258223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1447258223
Entity Type Individual
Full Name GARY THEODORE PEDERSON
Credential D.D.S.
Practice Address 1565 Liberty St Se
Salem
OR 97302-4345
Practice Telephone 5035810223
Practice Fax Number 5035816794
Mailing Telephone 5035810223
Mailing Fax Number 5035816794
Enumeration Date 2005-07-14
Last Update Date 2007-07-17
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1223S0112X Dentist
Specialization: Oral and Maxillofacial Surgery
D4658 OR Dental Providers

Other Providers GARY PEDERSON

NPI Name Taxonomy Address Enumeration
1215581913 Gary Duane Pederson Technician 111 Deer Trl Nw, Cleveland, TN 37312-1110 2019-07-31

Office Location

Street Address 1565 LIBERTY ST SE
City SALEM
State OR
Zip Code 97302-4345

Providers in the same location

NPI Name Taxonomy Address Enumeration
1386901734 Mid-valley Oral, Maxillofacial & Implant Surgery Clinic/Center 1565 Liberty St Se, Salem, OR 97302-4345 2012-04-23
1154517415 Gary T. Pederson Dentist 1565 Liberty St Se, Salem, OR 97302-4345 2007-09-20
1356320576 David C Swiderski Dentist 1565 Liberty St Se, Salem, OR 97302-4345 2006-01-16

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1952954679 Eric Anthony Bohm Pharmacist 2757 22nd St. Se, Salem, OR 97302 2019-07-22
1598223737 Michael Robert Martini Counselor 960 Liberty Rd Se Suite 120, Salem, OR 97302 2019-03-06
1659857480 Avalina Pharmacy Inc Pharmacy 3507 Commercial St Se, Salem, OR 97302 2018-07-16
1649762733 Joseph Bochsler Physical Therapist 3220 Liberty Rd. S., Salem, OR 97302 2018-06-04
1922533652 Brianne Elizabeth Sischo Licensed Practical Nurse 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 2017-05-01
1851825566 Modern Nose Clinic LLC Otolaryngology 340 Vista Ave Se, Ste 100, Salem, OR 97302 2017-04-19
1720529803 Nicholas Forsberg Massage Therapist 126 Mize Rd S, Salem, OR 97302 2017-03-09
1437691078 Kimo Mahi Specialist/Technologist, Other 2373 Kuebler Rd. S, Salem, OR 97302 2016-11-14
1588113278 New Life Family Medicine LLC Clinic/Center 842 Commercial Street Ne, Salem, OR 97302 2016-09-23
1073060117 Susan Morag Robnett Counselor 912 Fir Street South, Salem, OR 97302 2016-09-07
Find all providers in zip 97302

Taxonomy Information

Taxonomy Code 1223S0112X
Grouping Dental Providers
Classification Dentist
Specialization Oral and Maxillofacial Surgery

Taxonomy Definition

The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Notes: Source: Council on Dental Education and Licensure, American Dental Association

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1831686468 Jev A. Clark, Dmd, Md, LLC Dentist 120 Ramsgate Sq S Ste 110, Salem, OR 97302-5870 2018-04-19
1164712022 Travis Jon Hamilton Dentist 250 Church St Se Ste 102, Salem, OR 97301-3758 2011-04-12
1124242813 Dennis Douglas Johnson Dentist 410 Lancaster Dr Ne, Suite A, Salem, OR 97301-4794 2007-04-12
1407981855 George Michael Koumaras Dentist 143 Bogey Ln, Salem, VA 24153-6858 2007-02-23
1578666426 John C Tackett Dentist 102 N Harrison St, Salem, IN 47167-1426 2006-09-06
1609878172 James M. Eyre Jr. Dentist 250 Church St Se, Ste 102, Salem, OR 97301-8500 2005-08-13
1588665723 David Wesley Howerton Dentist 2266 Mission St Se, Salem, OR 97302-1267 2005-08-10
1174520548 Martin J. Mehr Dentist 120 Ramsgate Sq S, Suite 110, Salem, OR 97302-5868 2005-06-30
1972996197 Southwest Virginia Oral & Maxillofacial Surgery, Pllc Dentist 1940 Braeburn Dr, Suite A, Salem, VA 24153-7383 2015-03-12
1386041358 Erda Carmel Pradel Dentist 3490 Lancaster Dr Ne, Salem, OR 97305-1356 2014-11-19
Find all providers in SALEM

Competitor

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City SALEM
Zip Code 97302

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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