NPI 1699198663

Lillian Petersen, CDLLD

Practitioner Denturist Florence, OR

Practice location

Address: 524 Laurel Street, Florence, OR 97439-0004
Phone: (541) 997-6054
Fax: (541) 997-6054
Mailing address: PO Box 96, Florence, OR 97439-0004

Registered specialties

Denturist Primary

Dental Providers Taxonomy 122400000X Licence DT DO 706283 (OR)

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Registry record

NPI: 1699198663
Entity type: Individual
Sex (as registered): Female
NPI issued: 28 Jan 2014
Record last updated: 23 Sep 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.