Peter Brent Amundson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12101 Issued in OR

Practice address

124 NW Hawthorne Ave
Bend, OR 97703-2918

Phone

(303) 521-2916

Fax

(541) 389-2958

NPI assigned

Nov 1, 2006

Last updated

Sep 14, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Great Smile Dental of Bend LLC

  dba Aesthetic Dentistry of Bend

  • Dentist
  • Bend, OR
  • NPI 1285545608
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789344000000",
    "number": "1073690889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 NW HAWTHORNE AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977032918",
            "telephone_number": "303-521-2916",
            "fax_number": "541-389-2958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 NW HAWTHORNE AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977032918",
            "telephone_number": "303-521-2916",
            "fax_number": "541-389-2958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMUNDSON",
        "first_name": "PETER",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D12101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• American Medical Transit LLC
• Joel Amezcua, LAC
• Amie Schulz LCSW LLC
• Katherine Amman
• Anne Marie Amos
• Amy King LCSW LLC
• Amy Manion Family Therapy
• Rachel Anady
• Ananda Psychotherapy
• S Anandavalli, PHD, LPCA, NCC, CCTP

• General Practice Dentistry in Bend, OR
• Providers in Bend, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.