Gary T. Pederson

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D4658 Issued in OR

Legal business name

GARY T. PEDERSON

Practice address

1565 Liberty St SE
Salem, OR 97302-4345

Phone

(503) 581-0223

Fax

(503) 581-6794

NPI assigned

Sep 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gary T Pederson, DDSNPI 1447258223

Title

Oral Surgeon

Phone

(503) 581-0223

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary Theodore Pederson, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Salem, OR
  • NPI 1447258223
  NPD (past) Authorized official
• David C Swiderski, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Salem, OR
  • NPI 1356320576

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1154517415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1565 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024345",
            "telephone_number": "503-581-0223",
            "fax_number": "503-581-6794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1565 LIBERTY ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024345",
            "telephone_number": "503-581-0223",
            "fax_number": "503-581-6794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY T. PEDERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ORAL SURGEON",
        "authorized_official_telephone_number": "503-581-0223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D4658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra K Garrard, MD
• Christina Garrett
• Cort R Garrison, MD
• Susan Garson, RN
• Gary D Ollbrich Inc
• Alexanndra Rene Gaskey, FNP
• David A Gasser, DC
• Tyler Scott Gates
• Justin T Gathercoal, D.O.
• Theresa Diane Gatti, PHARMD, RPH

• Oral and Maxillofacial Surgery (Dentist) in Salem, OR
• Providers in Salem, OR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.