Daniel Petrisor DMD MD LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

DANIEL PETRISOR DMD MD LLC

Practice address

6464 SW Borland Rd Ste D3
Tualatin, OR 97062-8861

Phone

(214) 316-5743

NPI assigned

Feb 8, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Petrisor, DMD, MDNPI 1235332834

Title

Owner

Phone

(214) 316-5743

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.

• Daniel Petrisor, DMD, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Portland, OR
  • NPI 1235332834

  Oral and Maxillofacial Surgery

  NPD Authorized official
• Jonathan Jelmini, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Portland, OR
  • NPI 1477000164

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1549584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549584000000",
    "number": "1194280685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6464 SW BORLAND RD STE D3",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6464 SW BORLAND RD STE D3",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628861",
            "telephone_number": "214-316-5743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL PETRISOR DMD MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-08",
        "last_updated": "2019-02-08",
        "status": "A",
        "authorized_official_last_name": "PETRISOR",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-316-5743",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Cuddeford, Bai
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• Pamela Susan Dahm, M.S., CCC-SLP
• Margaret Dallas, DPT
• Nola Ranelle Dauenhauer
• Reid Thomas Davidson, DC
• Katy Davies
• Debra Kaye Davis, M.D.
• Elizabeth Chelsea Davis, RBAI

• Oral and Maxillofacial Surgery (Dentist) in Tualatin, OR
• Providers in Tualatin, 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 Feb 8, 2019; 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.