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General NPI Number Information
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NPI Number | 1770826224
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Entity Type | Individual
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Provider Name | PETER DENNIS MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 16455 BOONES FERRY RD STE B
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-4367
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Country | US
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Telephone | 503-482-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 0720 SW GAINES ST UNIT 213
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City | PORTLAND
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State | OR
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Zip | 97239-4650
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Country | US
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Telephone | 360-751-2921
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | MD198730
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2019-00625
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D9916
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License Number State | OR
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