MEDICARE: DR. CHRISTI ANN PETERSON D.M.D.

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	1223G0001X	General Practice Dentistry	29419	CA

General Provider Information

NPI Number	:	1568467975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTI ANN PETERSON D.M.D.

Provider Business Mailing Address
First Line	:	3772 KATELLA AVE
Second Line	:	STE 207
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-6429
Country	:	US
Telephone Number	:	562-493-6106
Fax Number	:	562-493-6235

Provider Business Practice Location Address
First Line	:	3772 KATELLA AVE
Second Line	:	STE 207
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-6429
Country	:	US
Telephone Number	:	562-493-6106
Fax Number	:	562-493-6235

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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