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General NPI Number Information
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NPI Number | 1225274442
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Entity Type | Organization
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Legal Business Name | DANIEL PETERSEN, DDS, INC.
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 2315 BECHELLI LN SUITE A
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City | REDDING
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State | CA
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Zip | 96002-0119
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Country | US
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Telephone | 530-223-1811
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Fax | 530-223-1813
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Provider Business Mailing Address
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Address Line | 2315 BECHELLI LN SUITE A
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City | REDDING
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State | CA
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Zip | 96002-0119
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Country | US
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Telephone | 530-223-1811
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Fax | 530-223-1813
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL PETERSEN
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Credential | D.D.S.
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Telephone | 530-223-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 57031
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License Number State | CA
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