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NPI Code Detail

MEDICARE: DR. STEVEN W. PETERSON D.M.D.

MEDICARE: DR. STEVEN W. PETERSON D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry7110AZ
21223G0001XGeneral Practice Dentistry6231NV

General Provider Information

NPI Number : 1477600666
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEVEN W. PETERSON D.M.D.
Provider Business Mailing Address
First Line : 10526 E AVALON PARK ST
Second Line :
City : TUCSON
State : AZ
Zip : 85747-5975
Country : US
Telephone Number : 702-273-6837
Fax Number :
Provider Business Practice Location Address
First Line : 1257 PAIUTE CIR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3202
Country : US
Telephone Number : 702-382-0784
Fax Number : 702-384-5272
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 02/20/2014

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