Alexander Gregory O'Neal Petersen, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D11692 Issued in OR

Practice address

11160 Highway 62
Eagle Point, OR 97524-8025

Phone

(541) 500-0763

NPI assigned

Sep 5, 2022

Sex

Male

Sole proprietor

No

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

• White River Health District

  • Family Medicine Physician
  • Maupin, OR
  • NPI 1841317237
  NPD
• Rogue Community Health

  • Federally Qualified Health Center (FQHC)
  • Eagle Point, OR
  • NPI 1790059731
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 25, 2026.

{
    "created_epoch": "1662336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1407577844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 DISK DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975016638",
            "telephone_number": "458-658-5930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11160 HIGHWAY 62",
            "city": "EAGLE POINT",
            "state": "OR",
            "postal_code": "975248025",
            "telephone_number": "541-500-0763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ALEXANDER",
        "middle_name": "GREGORY O'NEAL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-05",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith Fusao Ogawa, D.D.S.
• Nathan Olson, LCSW, QMHP, CADC III
• Tiana Lorene Olson, RDH
• Michelle Paquette, MA
• Megan Peters, LMT
• Austen Cimone Petersen, DMD
• Kasandra K Prill, LMT
• Providence Health & Services - Oregon
• Providence Health & Services - Oregon
• Robert L Nutting

• All providers in Eagle Point, OR
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2026; 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.