Provider Demographics
NPI:1295846376
Name:DEAN B PETTERSON DMD PC
Entity Type:Organization
Organization Name:DEAN B PETTERSON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-667-1001
Mailing Address - Street 1:121 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7215
Mailing Address - Country:US
Mailing Address - Phone:503-667-1001
Mailing Address - Fax:503-663-3500
Practice Address - Street 1:121 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7215
Practice Address - Country:US
Practice Address - Phone:503-667-1001
Practice Address - Fax:503-663-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty