MEDICARE: DR. LAUREN E PETERSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	37320	TX

General Provider Information

NPI Number	:	1386213692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN E PETERSON DDS

Provider Business Mailing Address
First Line	:	9060 TYNE TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-7505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 N BEACH ST STE 111
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1893
Country	:	US
Telephone Number	:	817-520-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	05/09/2023

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Directions to “ DR. LAUREN E PETERSON DDS” Practice Location

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