Healthcare Provider Details

I. General information

NPI: 1164718201
Provider Name (Legal Business Name): TERRY PETERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 E BELL RD STE 143
SCOTTSDALE AZ
85254-6010
US

IV. Provider business mailing address

5425 E BELL RD STE 143
SCOTTSDALE AZ
85254-6010
US

V. Phone/Fax

Practice location:
  • Phone: 480-613-3476
  • Fax:
Mailing address:
  • Phone: 602-953-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008234
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: