Healthcare Provider Details

I. General information

NPI: 1841308947
Provider Name (Legal Business Name): SCOTT S PETERS DDS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/09/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 W VISTA WAY
VISTA CA
92083-6020
US

IV. Provider business mailing address

1925 W VISTA WAY
VISTA CA
92083-6020
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-5000
  • Fax: 559-227-4457
Mailing address:
  • Phone: 559-226-5000
  • Fax: 559-227-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33353
License Number StateCA

VIII. Authorized Official

Name: DR. SCOTT STUART PETERS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 559-226-5000