Healthcare Provider Details

I. General information

NPI: 1437396025
Provider Name (Legal Business Name): ARIC M PETERSEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10752 N 89TH PL 117
SCOTTSDALE AZ
85260-6730
US

IV. Provider business mailing address

10752 N 89TH PL STE 117
SCOTTSDALE AZ
85260-6743
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-8888
  • Fax:
Mailing address:
  • Phone: 480-767-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2008020514
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2496
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: