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General NPI Number Information
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NPI Number | 1073690889
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Entity Type | Individual
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Provider Name | PETER BRENT AMUNDSON D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7900 S UNIVERSITY BLVD SUITE 100
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City | CENTENNIAL
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State | CO
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Zip | 80122-5102
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Country | US
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Telephone | 303-773-9400
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Fax | 303-773-9518
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Provider Business Mailing Address
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Address Line | 7960 S UNIVERSITY BLVD STE 200
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City | CENTENNIAL
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State | CO
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Zip | 80122
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Country | US
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Telephone | 303-773-9400
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Fax | 303-773-9518
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 007485
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License Number State | CO
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