| Gary T. Pederson | |
|
1565 Liberty St Se Salem OR 97302-4345 | |
| (503) 581-0223 | |
| (503) 581-6794 |
| Full Name | Gary T. Pederson |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1565 Liberty St Se, Salem, Oregon |
| Authorized Official Name and Position | Gary T Pederson (ORAL SURGEON) |
| Authorized Official Contact | 5035810223 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary T. Pederson 1565 Liberty St Se Salem OR 97302-4345 Ph: (503) 581-0223 | Gary T. Pederson 1565 Liberty St Se Salem OR 97302-4345 Ph: (503) 581-0223 |
| NPI Number | 1154517415 |
|---|---|
| Provider Enumeration Date | 09/20/2007 |
| Last Update Date | 09/20/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154517415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D4658 (Oregon) | Primary |
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