PETERSON PERIODONTICS & IMPLANTOLOGY LLC (NPI# 1801310008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801310008 |
| Entity Type | Organization |
| Organization Name | PETERSON PERIODONTICS & IMPLANTOLOGY LLC |
| Practice Address |
5528 Se Powell Blvd Portland OR 97206-2956 |
| Mailing Address |
4420 Se 51st Ave Portland OR 97206-3910 |
| Practice Telephone | 5037881008 |
| Mailing Telephone | 4068618844 |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2017-07-29 |
| Authorized Official Name | DR. ANDREW GREGORY PETERSON (PERIODONTIST, MEMBER OF LLC) |
| Authorized Official Telephone | 4068618844 |
| Authorized Official Credential | DMD, MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
D9905 | OR | Dental Providers |
| Street Address |
5528 SE POWELL BLVD |
| City | PORTLAND |
| State | OR |
| Zip Code | 97206-2956 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871585802 | Jerry J Yoon | Podiatrist | 5528 Se Powell Blvd, Portland, OR 97206-2956 | 2005-08-16 |
| 1114368354 | Quinn Robert Hummel | Dentist | 5528 Se Powell Blvd, Portland, OR 97206 | 2013-07-16 |
| 1851557607 | Ankle and Foot Clinic of Oregon | Clinic/Center | 5528 Se Powell Blvd, Portland, OR 97206-2956 | 2008-07-31 |
| 1174709448 | Dewey Dental, P.C. | Dentist | 5528 Se Powell Blvd, Portland, OR 97206-2956 | 2008-01-16 |
| 1467445387 | Wayne A Vetter | Podiatrist | 5528 Se Powell Blvd, Portland, OR 97206-2956 | 2005-08-25 |
| 1275526527 | Donald H Wheeler Dmd PC | Dentist | 5528 Se Powell Blvd, Portland, OR 97206-2956 | 2005-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346852365 | Amanda Kristine Fredrickson | Dietitian, Registered | 3611 Se 64th Ave., Portland, OR 97206 | 2020-08-20 |
| 1578108940 | Amy Groulx | Technician | 5506 Se Mitchell St, Portland, OR 97206 | 2019-11-08 |
| 1477061265 | Lisa Marie Matejka | Naturopath | 5235 Se Lambert St, Apt. #b6, Portland, OR 97206 | 2018-01-16 |
| 1639625205 | Mollie Kathleen Pence | Registered Nurse | 2415 43rd Ave, Suite 100, Cascadia Behavioral Healthcare Urgent Walkin Clinic, Portland, OR 97206 | 2016-09-01 |
| 1457709164 | Lauren Murdoch | Massage Therapist | 4629 Southeast Woodstock Boulevard, Portland, OR 97206 | 2016-06-03 |
| 1962897785 | Meigra Simon LLC | Mechanotherapist | 6842 Se Henry St, Portland, OR 97206 | 2015-03-30 |
| 1891186508 | Teresa Leckron-myers | Case Manager/Care Coordinator | 7916 Se Foster Rd, Portland, OR 97206 | 2015-02-17 |
| 1831597590 | Boey Yean Lim | Acupuncturist | 4629 Se Woodstock Blvd, Portland, OR 97206 | 2014-12-12 |
| 1295082329 | Chase Heywood Price | Acupuncturist | 5425 Se Raymond Street, Portland, OR 97206 | 2012-08-08 |
| 1154678423 | Annelise Sevastiana Schnase | Counselor | 4311 Se Woodstock Blvd, Portland, OR 97206 | 2012-08-06 |
| Find all providers in zip 97206 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871026062 | Leila Soltani | Dentist | 430 Sw 13th Ave Apt 2010, Portland, OR 97205 | 2017-04-05 |
| 1730632266 | Samar Shaikh | Dentist | 716 Stevens Ave # 204, Portland, ME 04103 | 2016-08-02 |
| 1730472986 | Wilson D Lee | Dentist | 315 Nw Lost Springs Ter, #401, Portland, OR 97229-6444 | 2011-05-20 |
| 1184954422 | Kamran Haghighat Bds Ms PC | Dentist | 833 Sw 11th Ave Ste 1020, Portland, OR 97205-2124 | 2010-01-08 |
| 1225292121 | Harjit Singh Sehgal | Dentist | 2730 Sw Moodey Ave, Clsb-5n034, Portland, OR 97201 | 2008-07-10 |
| 1467516211 | Chirgwin & Herriges, LLC | Dentist | 1130 Se 122nd Ave, Portland, OR 97233-1112 | 2006-12-19 |
| 1568534519 | Trang N Pham | Dentist | 10356 Ne Wasco St, Portland, OR 97220 | 2006-11-14 |
| 1811086887 | Winthrop B. Carter | Dentist | 611 Sw Campus Drive, Ohsu School of Dentistry, Sd 177, Portland, OR 97239 | 2006-10-11 |
| 1295828069 | Southern Maine Periodontal Assoc Pa | Dentist | 276 Canco Rd, Portland, ME 04103 | 2006-10-02 |
| 1598702151 | Angela Blizzard | Dentist | 7107 Sw Macadam Ave, Portland, OR 97219-3075 | 2006-06-01 |
| Find all providers in PORTLAND | ||||
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| 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.