MYRON T PENG (NPI# 1417144387) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417144387 |
| Entity Type | Individual |
| Full Name | MYRON T PENG |
| Credential | DMD |
| Practice Address |
9605 Grand Ronde Rd Grand Ronde OR 97347-9712 |
| Mailing Address |
Po Box 338 Grand Ronde OR 97347-0338 |
| Practice Telephone | 5038792236 |
| Practice Fax Number | 5038795089 |
| Mailing Telephone | 5038792236 |
| Mailing Fax Number | 5038795089 |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2007-09-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D8970 | OR | Dental Providers |
| Street Address |
9605 GRAND RONDE RD |
| City | GRAND RONDE |
| State | OR |
| Zip Code | 97347-9712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932180734 | Lance Gregory Loberg | Family Medicine | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2005-11-08 |
| 1003286840 | Albert Martineau | Counselor | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2015-10-06 |
| 1417390634 | Andrew R Canning | Student in an Organized Health Care Education/Training Program | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2013-04-08 |
| 1104164359 | Confederated Tribes of Grand Ronde Community of Oregon Dba Gr Health & | Clinic/Center | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2013-01-23 |
| 1508111931 | Capitol Physical Therapy, Inc | Physical Therapist | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2012-07-23 |
| 1477845352 | Jeanette Marie Kaschmitter | Counselor | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2011-05-10 |
| 1366765687 | George Ryan Davis | Dentist | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2010-03-02 |
| 1467692350 | Ashley Rose Nunley | Chiropractor | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2009-03-05 |
| 1477711802 | Confederated Tribes of The Grand Ronde Community of Oregon | Pharmacy | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2008-06-02 |
| 1881875375 | Lincoln Wright | Pharmacist | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2007-11-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023325859 | Linda 'lynn' Michelle House | Licensed Practical Nurse | 7650 Birch Street, Grand Ronde, OR 97347-0024 | 2010-08-31 |
| 1689700213 | Angela R Vargas | Counselor | 9615 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2007-02-26 |
| 1326513367 | Confederated Tribes of Grand Ronde Community of Oregon | Radiology | 9615 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2018-10-05 |
| 1922554542 | Terri Knowles | Optometrist | 9615 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2016-09-01 |
| 1093073439 | Nicole Marie Estrada | Counselor | 9615 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2012-04-23 |
| 1881970069 | Sarah J Ross | Speech-Language Pathologist | 9615 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2011-11-01 |
| 1073709499 | Erin Margaret Lange | Dentist | 9615 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2007-09-19 |
| 1477720365 | Martie M Coblentz | Contractor | 27725 Jahn Rd, Grand Ronde, OR 97347-9735 | 2008-05-11 |
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366765687 | George Ryan Davis | Dentist | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2010-03-02 |
| 1154464295 | E. Eric Webster | Dentist | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2007-02-15 |
| 1528101565 | Rachel Sherfey Botelho | Dentist | 9605 Grand Ronde Rd, Grand Ronde, OR 97347-9712 | 2007-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700486438 | Jane Jeeyoon Kim | Dentist | 14425 Sw Allen Blvd # 1, Beaverton, OR 97005-4402 | 2020-10-30 |
| 1780283556 | Ziyad Amir Kadir | Dentist | 300 Tatone St, Boardman, OR 97818-7900 | 2020-10-22 |
| 1295333912 | John Andrew Fawcett | Dentist | 214 Jersey St, Silverton, OR 97381-1627 | 2020-10-14 |
| 1629685920 | Alexandroff Dmd PC | Dentist | 1085 E Harbor Drive, Warrenton, OR 97146 | 2020-09-30 |
| 1760097034 | Hannah Glazunov | Dentist | 4970 S Landing Dr Unit 302, Portland, OR 97239-5900 | 2020-09-13 |
| 1235742198 | Geoffrey Houf | Dentist | 5880 Ne Cornell Rd Ste D, Hillsboro, OR 97124-9075 | 2020-08-28 |
| 1124631650 | Sugandha Gupta | Dentist | 2561 Nw 167th Ave, Beaverton, OR 97006-7643 | 2020-08-25 |
| 1609489137 | Open Door Dental Group PC | Dentist | 1710 E Pine St Ste A, Central Point, OR 97502-2811 | 2020-08-25 |
| 1720698566 | Travis Alcorn | Dentist | 2750 Kingwood St, Florence, OR 97439-9556 | 2020-08-06 |
| 1811506322 | Ruiwei Liang | Dentist | 547 Se 73rd Ave, Hillsboro, OR 97123-6199 | 2020-07-30 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RONDE |
| Zip Code | 97347 |
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| 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.