DANIEL PETRISOR, DMD, MD PORTLAND, OR

Contact Information

DANIEL PETRISOR, DMD, MD

3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239-3011

Phone: 503-494-8916
Fax: 503-494-6783
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Oral & Maxillofacial Surgery	204E00000X	02	Physician/General Surgery
Oral and Maxillofacial Surgery	1223S0112X	19	Oral Surgery (Dentist only)

Indicates primary specialty

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NPI Profile & details for DANIEL PETRISOR · (Male)

NPI Number	`1235332834`
Status	Active
Credentials	DMD, MD
Entity	Individual
Enumeration date	06/09/2007
Last updated	07/16/2025 - About 11 months ago
Sole proprietor ¹	No
Identifiers	OR License # D9059 OR License # MD154906 FL Medicaid 0022923-00 OR Medicaid 500651136 OR Medicaid 500654224 Other BP1-0026540 INSTITUTIONAL PERMIT FL Other 148H9 BCBS FL
Hospital affiliation(s)	OHSU HOSPITAL AND CLINICS - (Acute Care) 3181 SW SAM JACKSON PARK ROAD PORTLAND, OR 97239

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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DANIEL PETRISOR, DMD, MD – NPI #1235332834Oral & Maxillofacial Surgery

Contact Information

Specialty

Oral & Maxillofacial Surgery

Oral and Maxillofacial Surgery

NPI Profile & details for DANIEL PETRISOR · (Male)

Reviews for DANIEL PETRISOR

DANIEL PETRISOR, DMD, MD – NPI #1235332834
Oral & Maxillofacial Surgery