Peterson Orthodontics & Periodontics, LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

PETERSON ORTHODONTICS & PERIODONTICS, LLC

Doing business as

Lake Oswego Orthodontics
Lake Oswego Orthodontics & Periodontics
Lake Oswego Periodontics

Practice address

15962 Boones Ferry Rd Ste 108
Lake Oswego, OR 97035-4359

Phone

(503) 699-6569

NPI assigned

Jul 28, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Vanessa N B Peterson, DDS, MS

Title

Orthodontist, Member of LLC

Phone

(909) 518-7743

Specialties & licenses 2

Addresses

Other names 3

• Lake Oswego Orthodontics Doing business as
• Lake Oswego Orthodontics & Periodontics Doing business as
• Lake Oswego Periodontics Doing business as

Locations

Practitioners 1

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

• Andrew Gregory Peterson, DMD, MS

  • Periodontics
  • Claremont, CA
  • NPI 1619318755
  NPD (past)

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

{
    "created_epoch": "1501200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1457875700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 SE 51ST AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972063910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15962 BOONES FERRY RD STE 108",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354359",
            "telephone_number": "503-699-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON ORTHODONTICS & PERIODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-28",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "N B",
        "authorized_official_title_or_position": "ORTHODONTIST, MEMBER OF LLC",
        "authorized_official_telephone_number": "909-518-7743",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Oswego Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Oswego Orthodontics & Periodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Oswego Periodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Perine
• Anne Elizabeth Pernichele, DC
• Lisa Lynn Perreault, PT
• Dylann Perrone
• Carly Christoferson Petersen, DMD
• Larry Len Peterson, M.D.
• Noel S. Peterson, N.D.
• Charles Justin Petit, M.D.
• Mark A. Petroff, M.D.
• Amalia Margaret Iwasaki Pfeifer, PT

• Orthodontics and Dentofacial Orthopedics Dentistry in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.