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General NPI Number Information
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NPI Number | 1093376576
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Entity Type | Organization
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Legal Business Name | PETER B. IVERSEN JR., DDS, PLLC.
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 4700 42ND AVE SW STE 555
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City | SEATTLE
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State | WA
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Zip | 98116-4583
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Country | US
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Telephone | 206-935-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 42ND AVE SW STE 555
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City | SEATTLE
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State | WA
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Zip | 98116-4583
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER B. IVERSEN
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Credential | DDS
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Telephone | 206-403-8651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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