MEDICARE: DR. AUSTEN CIMONE PETERSEN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D11691	OR

General Provider Information

NPI Number	:	1417678848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTEN CIMONE PETERSEN DMD

Provider Business Mailing Address
First Line	:	1221 DISK DR
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-6638
Country	:	US
Telephone Number	:	458-658-5930
Fax Number	:

Provider Business Practice Location Address
First Line	:	11160 HIGHWAY 62
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-8025
Country	:	US
Telephone Number	:	541-500-0763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	05/13/2026

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