Peticolas, Cynthia Marion

Peticolas, Cynthia Marion is an sole proprietor health care provider with primary practice located at 548 S 1St Ave , Mill City OR 97360. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Peticolas, Cynthia Marion can be contacted via phone (503) 897-2353.

Contact Information

Primary practice address
548 S 1St Ave Mill City OR 97360
Fax: (503) 897-2354
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 5986 Oregon

Profile Details

NPI number 1134180714
LBN Legal business name Peticolas, Cynthia Marion
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 31st, 2006
Last updated May 26th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134180714 NPPES
Oregon MEDICAID 265439

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