PETER DOUGLAS

PORTLAND, OR
NPI1861999864
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1223P0221X Dentist, Pediatric Dentistry
(Licence: OR  D11970)
Additional Taxonomies1223P0221X Dentist, Pediatric Dentistry
(Licence: WA  61039600)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2018-04-07
Last Update Date2024-09-09
Business Address
PETER DOUGLAS DDS
10300 SE WASHINGTON ST STE C101
PORTLAND, OR 97216-2805
Phone number: 503-776-3091
Mailing Address
PETER DOUGLAS DDS
1204 SE 34TH AVE
PORTLAND, OR 97214-4222
Phone number: 712-560-6260