Healthcare Provider Details

I. General information

NPI: 1215619945
Provider Name (Legal Business Name): ARIC PETERSEN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-780-7802
  • Fax: 480-767-8818
Mailing address:
  • Phone: 314-780-7802
  • Fax: 480-767-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ARIC PETERSEN
Title or Position: OWNER
Credential: DDS
Phone: 314-780-7802