Healthcare Provider Details

I. General information

NPI: 1588907844
Provider Name (Legal Business Name): PETER SON DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8359
License Number StateNC

VIII. Authorized Official

Name: DR. PETER SON
Title or Position: OWNER
Credential: DMD
Phone: 336-625-4216