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General NPI Number Information
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NPI Number | 1184830788
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Entity Type | Organization
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Legal Business Name | PETERSON DENTAL GROUP, PC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 669 N STEPHANIE ST
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City | HENDERSON
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State | NV
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Zip | 89014-2634
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Country | US
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Telephone | 702-435-3827
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Fax | 702-435-3973
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Provider Business Mailing Address
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Address Line | PO BOX 872710
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City | VANCOUVER
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State | WA
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Zip | 98687-2710
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Country | US
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Telephone | 360-869-7645
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Fax | 877-725-7443
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Authorized Official
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Title or Position | PC OWNER/PRESIDENT
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Name | DR. BRADLEY R PETERSON
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Credential | DDS
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Telephone | 360-869-7645
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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 |
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License Number State |
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