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General NPI Number Information
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NPI Number | 1053585679
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Entity Type | Organization
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Legal Business Name | DAVID PETERSON, INC.
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 4124 ARDMORE AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93309-4982
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Country | US
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Telephone | 661-834-4111
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Fax | 661-834-0927
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Provider Business Mailing Address
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Address Line | 4124 ARDMORE AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93309-4982
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Country | US
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Telephone | 661-834-4111
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Fax | 661-834-0927
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Authorized Official
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Title or Position | OWNER
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Name | DAVID PETERSON
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Credential | D.D.S.
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Telephone | 16618344111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 52770
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License Number State | CA
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