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Contact Information

CYNTHIA M PETICOLAS, DMD
548 S 1ST AVE
MILL CITY, OR97360
 Phone: 503-897-2353
 Fax: 503-897-2354
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for CYNTHIA M PETICOLAS · (Female)

NPI Number 1134180714
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 03/31/2006
Last updated 05/26/2015 - About 11 years ago
Sole proprietor 1 Yes
Identifiers
  • OR License # 5986
  • OR Medicaid 265439
Hospital affiliation(s) Not Available
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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