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General NPI Number Information
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NPI Number | 1407411218
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Entity Type | Individual
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Provider Name | ALEXANDER JAMES PETERSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 2165 N TELEGRAPH RD
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City | MONROE
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State | MI
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Zip | 48162-8947
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Country | US
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Telephone | 734-243-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 2517 BROOKWOOD DR
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City | MIDLAND
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State | MI
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Zip | 48640-2430
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Country | US
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Telephone | 989-708-0236
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901600150
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License Number State | MI
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