Provider Type Icon

DANIEL PETRISOR DMD MD NPI 1235332834


NPI Information

NPI: 1235332834
Provider Name: DANIEL PETRISOR, DMD, MD
Classification: Oral & Maxillofacial Surgery - 204E00000X
Entity Type: Individual
Organization: OREGON HEALTH AND SCIENCES UNIVERSITY/UNIVERSITY MEDICAL GROUP

PECOS Registration: Yes

Address:
3181 SW SAM JACKSON PARK RD
PORTLAND, OR
ZIP 97239
Phone: (503) 494-8914
Get Directions

Daniel Petrisor, DMD, MD is an oral maxillofacial surgery in Portland, OR. The provider is 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. Daniel Petrisor, DMD, MD NPI is 1235332834. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3181 SW SAM JACKSON PARK RD
PORTLAND, OR
ZIP 97239-011
Phone: (503) 494-8914
Fax: (503) 494-0294

The NPI 1235332834 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • X-ray imaging of teeth (HCPCS:70355)

The enumeration date for this NPI number is 6/9/2007 and was last updated on 10/13/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1204E00000XOral & Maxillofacial SurgeryME16886FLORIDANo
2204E00000XOral & Maxillofacial SurgeryMD154906OREGONYes
3204E00000XOral & Maxillofacial SurgeryD9059OREGONNo
4390200000XStudent in an Organized Health Care Education/Training Program21547TEXASNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1BP1-0026540OTHERINSTITUTIONAL PERMIT
2R168529MEDICARE PINOREGON
3148H9OTHERFLORIDABCBS FL
40022923-00MEDICAIDFLORIDA
5500651136MEDICAIDOREGON
6500654224MEDICAIDOREGON
7DK047ZMEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.