Provider Demographics
NPI:1528068657
Name:YONAN, PETER M (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:YONAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 NW COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3257
Mailing Address - Country:US
Mailing Address - Phone:541-383-0754
Mailing Address - Fax:541-383-8128
Practice Address - Street 1:625 NW COLORADO AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3257
Practice Address - Country:US
Practice Address - Phone:541-383-0754
Practice Address - Fax:541-383-8128
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice