DANIEL PETRISOR (NPI# 1235332834) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235332834 |
| Entity Type | Individual |
| Full Name | DANIEL PETRISOR |
| Credential | DMD, MD |
| Practice Address |
3181 Sw Sam Jackson Park Rd Portland OR 97239-3011 |
| Practice Telephone | 5034948914 |
| Practice Fax Number | 5034940294 |
| Mailing Telephone | 5034948914 |
| Mailing Fax Number | 5034940294 |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2014-10-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204E00000X | Oral & Maxillofacial Surgery | D9059 | OR | Allopathic & Osteopathic Physicians |
| Y | 204E00000X | Oral & Maxillofacial Surgery | MD154906 | OR | Allopathic & Osteopathic Physicians |
| N | 204E00000X | Oral & Maxillofacial Surgery | ME16886 | FL | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 21547 | TX | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 0022923-00 | 05 | |
| OR | 500651136 | 05 | |
| OR | 500654224 | 05 | |
| INSTITUTIONAL PERMIT | BP1-0026540 | 01 | |
| FL | BCBS FL | 148H9 | 01 |
| Street Address |
3181 SW SAM JACKSON PARK RD |
| City | PORTLAND |
| State | OR |
| Zip Code | 97239-3011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972506301 | Jerris Robert Hedges | Emergency Medicine | 3181 Sw Sam Jackson Park Rd, # L-102, Portland, OR 97239-3011 | 2005-05-31 |
| 1114528486 | Nathan Stencel | Student in an Organized Health Care Education/Training Program | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3098 | 2020-11-04 |
| 1073113064 | Evan Mitchell | Student in an Organized Health Care Education/Training Program | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2020-10-28 |
| 1629678834 | Vanessa Davie | Student in an Organized Health Care Education/Training Program | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2020-10-27 |
| 1952901480 | Jackie Kim Sharpe | Pharmacist | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2020-10-26 |
| 1922607530 | Leah Snyder | Student in an Organized Health Care Education/Training Program | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3098 | 2020-10-23 |
| 1932708740 | Blake Beneville | Student in an Organized Health Care Education/Training Program | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3098 | 2020-10-22 |
| 1154920833 | Isabelle Nguyen | Student in an Organized Health Care Education/Training Program | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2020-10-22 |
| 1124627054 | Musah N Iddrisu | Student in an Organized Health Care Education/Training Program | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2020-10-21 |
| 1386242105 | Wenelia Baghoomian | Student in an Organized Health Care Education/Training Program | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2020-10-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558979468 | Elise Caitlin Esposito | Student in an Organized Health Care Education/Training Program | 3710 Sw U.S. Veterans Hospital Road, Dental Service P-3 Dent, Attn: Elise Esposito, Portland, OR 97239 | 2020-07-16 |
| 1750908844 | Will Cowan | Student in an Organized Health Care Education/Training Program | 455 Sw Us Veterans Hospital Road., Portland, OR 97239 | 2020-07-06 |
| 1881219657 | Desiree Baer | Licensed Vocational Nurse | Sw Us Veterans Hospital Rd, Portland, OR 97239 | 2020-06-08 |
| 1285266205 | Melissa Irene Wheeler | Registered Nurse | Uhs-8l, 3181 S.w. Sam Jackson Park Road, Portland, OR 97239 | 2020-02-07 |
| 1225687981 | Pheba Mariam Jones | Pharmacist | Ohsu Pharmacy At Chh Building 2, 3303 Sw Bond Ave Rm 1090, Portland, OR 97239 | 2019-09-05 |
| 1801448063 | Alice Huang Huang | Student in an Organized Health Care Education/Training Program | 3710 Sw Veterans Road, Portland, OR 97239 | 2019-07-09 |
| 1710446273 | Ellen Noreen Kessi | Social Worker | 3710 Sw Us Veterans Rd., Portland, OR 97239 | 2019-03-14 |
| 1508335704 | Jacqueline Marie Mular | Marriage & Family Therapist | 5550 Sw Macadam Suite 100, Portland, OR 97239 | 2018-11-16 |
| 1275030926 | Carly Elizabeth Dougher | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd., Portland, OR 97239 | 2018-04-10 |
| 1780188094 | Dennis John Samuel | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd. L-579, Portland, OR 97239 | 2018-03-21 |
| Find all providers in zip 97239 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346249281 | Bryce Earl Potter | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Ste 300, Portland, OR 97209-1453 | 2005-07-20 |
| 1053864561 | Karl Cuddy | Oral & Maxillofacial Surgery | 2801 N Gantenbein Ave, Portland, OR 97227-1623 | 2016-08-01 |
| 1104209386 | Felix Wiyanto Sim | Oral & Maxillofacial Surgery | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2015-07-07 |
| 1407109937 | Providence Health & Services - Oregon | Oral & Maxillofacial Surgery | 4805 Ne Glisan St, Suite 6n50, Portland, OR 97213-2933 | 2012-10-22 |
| 1447525852 | Brett A. Ueeck Dmd, Md, PC | Oral & Maxillofacial Surgery | 11786 Sw Barnes Rd Ste 110, Portland, OR 97225-5926 | 2012-03-19 |
| 1588939961 | Marcus Aaron Couey | Oral & Maxillofacial Surgery | 1849 Nw Kearney St Ste 300, Portland, OR 97209-1453 | 2012-03-18 |
| 1043537707 | Allen C Cheng | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Suite 300, Portland, OR 97209 | 2010-04-21 |
| 1043415870 | Ashish A Patel | Oral & Maxillofacial Surgery | 1849 Nw Kearney St, Suite 300, Portland, OR 97209 | 2007-06-20 |
| 1790889376 | Maine Medical Partners | Oral & Maxillofacial Surgery | 22 Bramhall St, Dept of Surgery, Portland, ME 04102-3134 | 2006-09-12 |
| 1841208303 | Thomas William Albert | Oral & Maxillofacial Surgery | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2006-08-03 |
| Find all providers in PORTLAND | ||||
Please comment or provide details below to improve the information on DANIEL PETRISOR.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.