Healthcare Provider Details

I. General information

NPI: 1811819022
Provider Name (Legal Business Name): CHASE PETERSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S COOLIDGE ST
MOSES LAKE WA
98837-1873
US

IV. Provider business mailing address

23864 N 162ND LN
SURPRISE AZ
85387-1735
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-0674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDENT.DE.70139556
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: