Carly K Christoferson DMD PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CARLY K CHRISTOFERSON DMD PC

Practice address

3900 Douglas Way
Lake Oswego, OR 97035-3446

Phone

(503) 636-8446

Fax

(503) 636-4446

NPI assigned

Mar 2, 2022

Last updated

Mar 2, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carly Christoferson Petersen, DMDNPI 1841844354

Title

President

Phone

(503) 758-8174

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, and the practitioner matching its NPPES authorized official.

• Carly Christoferson Petersen, DMD

  • General Practice Dentistry
  • Lake Oswego, OR
  • NPI 1841844354
  NPD Authorized official
• Timothy John Edvalson, D.M.D.

  • General Practice Dentistry
  • Lake Oswego, OR
  • NPI 1205821154
  NPD (past)

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

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1548917321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 DOUGLAS WAY",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353446",
            "telephone_number": "503-636-8446",
            "fax_number": "503-636-4446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 DOUGLAS WAY",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353446",
            "telephone_number": "503-636-8446",
            "fax_number": "503-636-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLY K CHRISTOFERSON DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-02",
        "last_updated": "2022-03-02",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "CARLY",
        "authorized_official_middle_name": "CHRISTOFERSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-758-8174",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Canfield, LMT
• Susan Elizabeth Cantoni, OTR/L
• Heather Macdonald Cantrell, L.M.T.
• Muriel Capdepon, LMT
• Jessica Ann Carlin, HAS
• Jennifer Carnegie, R.N.
• Patrick Joseph Caroline, COT
• Kelsey Carroll
• Thomas G Carver, M.D.
• Cascade Oral and Facial Surgery, LLC (Cascade Oral and Facial Surgery)

• Dental Clinic/Center in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Dental Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; 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.