| Family Dental Clinic | |
|
607 Ne 3rd St Prineville OR 97754-2021 | |
| (541) 447-3855 | |
| (541) 416-9580 |
| Full Name | Family Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 607 Ne 3rd St, Prineville, Oregon |
| Authorized Official Name and Position | James G. Petersen (OWNER/DENTIST) |
| Authorized Official Contact | 5414473855 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dental Clinic 607 Ne 3rd St Prineville OR 97754-2021 Ph: (541) 447-3855 | Family Dental Clinic 607 Ne 3rd St Prineville OR 97754-2021 Ph: (541) 447-3855 |
| NPI Number | 1629487897 |
|---|---|
| Provider Enumeration Date | 08/12/2014 |
| Last Update Date | 08/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629487897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D10117 (Oregon) | Primary |
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