Healthcare Provider Details

I. General information

NPI: 1528248317
Provider Name (Legal Business Name): PETER I SON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N COX ST STE 18
ASHEBORO NC
27203-5514
US

IV. Provider business mailing address

75403 ROWAN
CHAPEL HILL NC
27517-8577
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-4216
  • Fax: 336-629-9317
Mailing address:
  • Phone: 919-636-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8359
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: